SIGN UP FOR PRIVATE SESSIONS

Please fill out the form below to register for your private session. Card will be charged day of the session.

Student Name

First Name

Last Name

Pronouns

Student Date of Birth

Month/Day/Year

Student Email Address

Student's Grade and School They Attend (if applicable)

Student Phone

(###)

###

####

Parent/Guardian Name (If under 18)

Parent Email Address

Parent Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Allergies / Medical Concerns?

Emergency Contact

Name/Number/Relation (not listed above)

Card Number

You will not be charged until day of the private session.

Name As it Appears on Card

Expiration Date

MM/YY

CVV

Billing Zip Code

Session Time

30 min $50

60 min $100

Are You Looking for Recurring Lessons?

Yes

Maybe

Why do you want to take private lessons? What are your goals?

Any other thoughts or questions?

SIGN UP FOR PRIVATE SESSIONS

ADDRESS / CONTACT

SITE LINKS

CONNECT WITH US

© 2023. Actors Playground School of Theatre.