Theatre Registration | Pakachoag Music School

School Year Theater Registration

2022-2023 Theatre

Please complete the form below and make payment via PayPal if possible. No PayPal account is required. You may use any credit or debit card. If you wish to pay by check, please send your check within 2 business days of submitting this form. If you wish to pay by cash, please call the office to arrange a drop off time at 508-791-8159, Monday to Friday. Registration is completed when payment received. Thank you!

"*" indicates required fields

Step 1 of 3

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Parent/Caregiver Name*

First Last

Parent/Caregiver Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City ZIP / Postal Code

Phone*

Please provide your primary phone number.

Phone 2

Do you have a second phone number you wish to provide?

Send/Receive Texts?

Yes

Section Break

Number of Students Registering Today

How many children are your registering today?

one

two

three

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.

Quinsigammond Elementary School

Elm Park Community School

African Community Education / ACE

Boys & Girls Club of Worcester

CENTRO

Black Excellence Academy /BEA

None of the Above

Student 1 Name*

First Last

Date of birth*

MM slash DD slash YYYY

What grade is Student 1 entering or in?*

Student 1 - Tuition and Registration Fee*

If you are enrolled with a partner organization, you qualify for fast track financial aid. (Quinsigammond Elementary, ACE, BEA, Centro, B&G Club of Worcester, Elm Park School).

No partner affiliation student - $20 reg fee + $220 tuition: $240

Returning Student - No Reg Fee: $220

Partner student: reg fee; tuition waived: $20

I'd like to request waiver of the registration fee due to financial circumstances. We'll follow up.

I plan to apply for financial aid. We'll follow up.

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 and Registration Fee*

If you are enrolled with a partner organization, you qualify for fast track financial aid. (Quinsigammond Elementary, ACE, BEA, Centro, B&G Club of Worcester, Elm Park School).

No partner affiliation student - $20 reg fee + $200 tuition: $240

Returning Student - No Reg Fee: $220

Partner student: reg fee; tuition waived: $20

I'd like to request waiver of the registration fee due to financial circumstances. We'll follow up.

I plan to apply for financial aid. We'll follow up.

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 and Registration Fee*

If you are enrolled with a partner organization, you qualify for fast track financial aid. (Quinsigammond Elementary, ACE, BEA, Centro, B&G Club of Worcester, Elm Park School).

No partner affiliation student - $20 reg fee + $200 tuition: $240

Returning Student - No Reg Fee: $220

Partner student: reg fee; tuition waived: $20

I'd like to request waiver of the registration fee due to financial circumstances. We'll follow up.

I plan to apply for financial aid. We'll follow up.

Readiness*

Is your child or are your children on track with typical cognitive skills generally associated with Grade 2 to 5 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, feel free to include notes here.

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 or 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 debit or credit card

I will mail in check or deliver cash

I would like to request the registration fee be waived due to financial circumstances

I am not a partner student but would still like to apply for financial aid

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