Theatre Registration | Pakachoag Music School

Theatre with Music Registration

Fall 2024

Thank you for your interest in registering for the Fall 2024 Youth Theatre session.

Financial Aid: Please indicate if you are applying for financial aid on the registration form.

Credit/Debit Card Payment: While card payments are processed via PayPal, a PayPal account is not required to complete the transaction.

Check Payment: Please send a check within 2 days of submitting this form.

Please note that registration is complete once both a submitted form and payment have been received by the office.

Thank you!

Fall 2024 Theatre

"*" indicates required fields

Step 1 of 3

33%

Parent/Caregiver Name*

First Last

Parent/Caregiver Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City ZIP / Postal Code

Parent/Caregiver Cell Phone*

Please provide your primary phone number.

Texting

YES, the School may send texts to this number.

NO, I do not want to receive texts on this number.

Section Break

Number of Students

How many children are your registering today?

One Student Registering

Two Students Registering

Three Students Registering

Are you connected with .....

Please let us know if your child/ren are enrolled with any of the following. Families connected with a partner qualify for fast-track Financial Aid.

African Community Education (ACE)

Black Excellence Academy (BEA)

Boys & Girls Club of Worcester

CENTRO

Chandler Magnet Elementary School

Elm Park Community School

Quinsigamond Elementary School

None of the Above

Student 1 Name*

First Last

Student 1 Date of Birth*

MM slash DD slash YYYY

What grade is Student 1 entering or in?*

Student 1 Tuition*

If you are enrolled with a partner organization, you qualify for fast-track financial aid. (Quinsigamond Elementary, ACE, BEA, CENTRO, B&G Club of Worcester, Chandler Magnet Elementary, Elm Park Elementary).

Standard Tuition ($240) + Registration Fee ($40)

I wish to apply for Financial Aid (The office will follow-up directly.)

Student 2 Name

First Last

Student 2 Date of Birth

MM slash DD slash YYYY

What grade is Student 2 entering or in?

Student 2 Tuition*

Standard Tuition ($240) + Registration Fee ($40)

I wish to apply for Financial Aid (The office will follow-up directly.)

Student 3 Name

First Last

Student 3 Date of Birth

MM slash DD slash YYYY

What grade is Student 3 entering or in?

Student 3 Tuition*

Standard Tuition ($280)

I wish to apply for Financial Aid (The office will follow-up directly.)

Readiness*

Is your child or are your children on track with typical cognitive skills generally associated with Grade 2 to 8 learning? If your answer is no, we'll follow up to assist in deciding if this class is the right placement for your child.

Yes

Other

About Your Child/ren

If there is something else you would like us to know about your child/ren, please include below.

How did you find us / hear about us?*

Word of Mouth: Friend/Family Referral

Word of Mouth: School Teacher Referral

Online: Social Media (Facebook, Instagram, Etc.)

Online: Search Engine (Google, Bing, Etc.)

Print Media: Newspaper, Concert Program, Etc.

Print Media: Brochure, Postcard, Etc.

Attended a Pakachoag Performance or Event

Other

Ethnicity for Grant Reporting - Primary Parent/Caregiver*

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Two or More Races

White

Prefer not to respond

Other

Ethnicity for Grant Reporting - Student 1*

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Two or More Races

White

Prefer not to respond

Other

Ethnicity for Grant Reporting - Student 2

Your response is appreciated and can be helpful in our ability to secure grant funding. Information is gathered for reporting purposes only.

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

Two or More Races

White

Prefer not to respond

Other

Photo /Video Permission*

Do you give Pakachoag Music School permission for yourself and/or your child(ren) to be photographed and/or videotaped during school functions for school purposes and for such photos or videos to be used commercially by the school, including postings on the School web site.

Yes

Other

PAYMENT

If you will be applying for financial aid and/or waiver of the registration fee, please note that we cannot process your registration until your status is confirmed.

Payment Method*

I will pay by Credit/Debit Card. (via PayPal - no account required)

I will pay by Check. (mail or delivery to the office within the next 2 days)

I am a partner student and request Financial Aid.

I am not a partner student but would still like to apply for Financial Aid.

Support a Student in Need*

Thank you for considering a donation to our Music Matters program that supports tuition assistance for children/youth of low income.

Yes, please add a $15 donation to my final payment.

Yes, I'd like to contribute to the average cost of a class, a $25 gift.

Yes, I'd like to pay for an upcoming lesson, a $45 gift.

Yes, I'd like to sponsor a student -- please provide more information.

No, Thank You.

Total

Payment Method

You do NOT need to have a PayPal account to make payment. Click the PayPal Checkout button and in the next window, choose the gray Pay by Credit or Debit Card button. Registration is not complete until payment is received.

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name