May River Montessori 60 Calhoun Street, Bluffton SC 29910 T: (843) 757-2321 F: (843) 757-4374

AFTER-SCHOOL DRAMA CLASSES AND PUBLIC SPEAKING CLASSES

WITH BETH GREEN, MRM DIRECTOR OF MUSIC

R E G I S T R AT I O N F O R M

Today’s Date

Child #1 Date of Birth & Age

Child #2 Date of Birth & Age

Child #1 Full Name

Child #1 Full Name

Parent/Guardian Name(s)

Address

Email address (I will never SPAM, or share your email address with others!)

Home Phone Number

Emergency contact

Phone #

Relationship to child

Allergies? Please detail here

Parent/Guardian’s Signature

Please print Parent/Guardian’s full name