Student Name *

First Name

Last Name

Parent Phone *

(###)

###

####

Student Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student Birthdate *

MM

DD

YYYY

I would like to enroll in Mary Poppins, JR *

Yes

No

I would like to enroll in CATS, Youth Edition *

Yes

No

Payment Choices *

Pay in Full

8 Monthly Payments

Payment Options *

Send check(s) to Birder Studio of Performing Arts: 123 S Broadway, De Pere, WI 54115

Set up monthly payments online (email ana@birderstudio.org for assistance)