Workshop Order Form
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General Information

Student Name:*
Age:*
Grade Just Completed:*
Address:*
City:*
State:*
Zip:*
Home Phone:*
Parent's Name:*
Daytime Phone:*
Email Address:*
Secondary Contact:
(in Case of Emergency)
Phone:
Relationship:

Previous Experience

Dance: # of Years
Voice: # of Years

Performances

Role #1:
Year:
Where:
Role #2:
Year:
Where:
Role #3:
Year:
Where:

T-Shirt Size (for Summer Workshops Only)

Child: S M L
Adult: S M L XL

Workshops

Summer Workshops: (View Class Details)
Preschool Sessions (Ages 5-7) (August 21-25) - $100
Beginner Sessions (Ages 8-12) (June 25-30) - $150
Beginner Sessions (Ages 8-12) (July 9-14) - $150
Beginner Sessions (Ages 8-12) (July 16-21) - $150
Beginner Sessions (Ages 8-12) (August 13-18) - $150
Beginner Sessions (Ages 12-17) (July 30 - August 4) - $150
Intermediate/Advanced Sessions (Ages 10-17) (July 23-28) - $150
 
Total Amount:
Payment options on following page.
Option #1: Pay directly via credit card.
Option #2: Login with your PayPal account.
Questions? Call the box office at 717-898-1900.		 $
 
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Dutch Apple Dinner Theatre :: 510 Centerville Road, Lancaster, PA 17601-1306
Phone: 717.898.1900 :: Fax: 717.898.1546 :: CONTACT US
© 2012, Dutch Apple Dinner Theatre. All Rights Reserved.