MIDDLESEX COUNTY ARTS Middle SCHOOL
APPLICATION 2018-2019 SEASON

Student's First Name:
 
Student's Last Name:
 
Address 1:
  Address 2 (Apt #):
City:
 
Zip:
Home Phone:
 
Cell Phone:
Email:
 
Date of Birth:
Mother's Email:
 
Father's Email:
School Attending:


Select Grade: Are you a returning student?
 
If yes, please list the name of the most recent class and year you attended.


Course: Year:

I would like to audition for the class.

(OPTIONAL) I would also like to audition for the class.

 
If you are auditioning for Jazz Improv, please specify which instrument you play:
     


 
  Please select payment method:  

*Audition Fees:   $50 for ONE Artform or
$70 for TWO Artforms
Name on card:
  Card number:
       Expiration date:  /

   CVV: