STG Associate Program

Enrollment Application

The Southside Theatre Guild Associate Program is available for students in grades 6-12. Participation fee is $50.

The program will take place on the first and third Saturday of each month beginning on September 3, 2022.

* indicates required fields

Student Information

Student Name *

Student Date of Birth *

Student Age *

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Student Grade (2023-2024 School Year) *

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Street Address *

City *

State *Select your stateGA - GeorgiaAK - AlaskaAL - AlabamaAR - ArkansasAZ - ArizonaCA - CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiIA - IowaID - IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA - MassachusettsMD - MarylandME - MaineMI - MichiganMN - MinnesotaMO - MissouriMS - MississippiMT - MontanaNC - North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM - New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVT - VermontWA - WashingtonWI - WisconsinWV - West VirginaWY - Wyoming

Zip *

Parent Information

Parent's Name *

Parent's Mobile # *

Parent's Email *

Emergency Contact Name *

Emergency Contact Number *

Name of Additional Person(s) Who May Pick Up This Student

I hereby release Southside Theatre Guild as well as any and all individuals involved with these activities, in perpetuity, on any liability(s) and claims therefore that might arise from my/my child's participation. *I authorize the program director to arrange emergency treatment by qualified personnel for my child. *

Payment

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