Winter Schedule 2018
First Name:* Last:*
Parents name:* Birthdate: Current Age:
Home Phone # Cell Phone #:
Emergency contact phone#:
City: State: Postal Code:
How did you hear about us?
Radio TV Email Yellow Pages Facebook/Social Media the Internet Newspaper Brochure Sign Referred by Other:
* = Required items
Select classes from the list below and then click the submit button at the bottom.
By checking this box, I state that I have read, and agree with, the policies of Vancil Performing Arts:
Parent/Guardian name: Date:
NOTE: After you click the Register button below, you will be taken to our Online Payments page.
Click the box above and then click the Register button below
Vancil Performing Arts Center
(217) 222-6857 • (877) 206-0736 • firstname.lastname@example.org