814 South Street
Studio Two
Peekskill, NY

Students Name___________________________________________Age_________Grade_______

Parent/Guardian Name______________________________________

Address_______________________________

City_____________________________State______Zip__________________

Telephone Cell___________________Home_________________Work_______________

E-mail______________________________

SPY Summer Performing Youth Programs
1.Two Hour workshop______________
$20 Paid Cash______ Check______
$15 Paid Cash______Check ______

2.One Week Intensive Theater/Dance_________________July 26th –30th
$200 Paid Cash______ Check _______Balance ______

“Annie” in Workshop Aug 2nd—21st
One week Aug 2nd----6th _____
Aug 9th----13th____
$175.00 Paid Cash____ Check____ Amount ________Balance_____

Two Weeks Aug 2nd- 13th ______
Aug 9th---21st ______
$250.00 Paid Cash_____Check____Amount ________Balance ____

Three Weeks Aug 2nd ---21st ______
$500.00 Paid Cash______Check ____Amount________Balance____