Print out form, complete, and return with payment to:

Little Actors' Theatre

PO Box 3601

Valdosta, GA 31604 

 LAT Proudly presents: Missoula Children’s Theatre, “The Little Mermaid,” registration is now being accepted for summer camp for children ages 6-19. Fees are $90.00 if post-marked before 5/15/11 and $100.00 after that date.

 Registration Form for Missoula Summer Camp

Our summer week-long camp will be held July 11-16, 2011; at Valdosta High School’s Performing Arts Center, 3101 N. Forrest St. Valdosta, GA.  The production this year is “The Little Mermaid”.  It promises to be another great experience.

Name:  __________________________________________________________________________

Age:     ______     Birthday_________        Grade  (must be entering 1^st grade)_____

Address:_________________________________________________________________________

              __________________________________________________________________________

Phone numbers           (H)___________________     (c)_______________________

E-Mail:_________________________________________________________________________

Parents Names:__________________________________________________________________

Payment of $90.00 before 5/15/11 and $100.00 after that date.

Cash_______Check_______ Money order______

Special Needs:_____________________________________________________________