Class Registration Form

Please print this page, fill out the form, and return to us with a check (made to Cocoon Theatre, Inc.), at:

Cocoon Theatre, Inc.
6384 Mill Street
Rhinebeck, NY 12572

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Name: ________________________________________

Street Address/ P.O. Box: ______________________________________________________

City, State, Zip: ___________________________________________________________

Phone(s): ____________________ ____________________ E-mail: _____________________

*Mother (name & address, if different): ________________________________________

Street Address/ P.O. Box: ______________________________________________________

City, State, Zip: ___________________________________________________________

*Father (name & address, if different): ________________________________________

Street Address/ P.O. Box: ______________________________________________________

City, State, Zip: ___________________________________________________________

Class Title: __________________________________________________________

Day(s) of Week: ____________________________ Time of Day: _____________________

Tuition: _________

Amount enclosed: _______________ Check/M.O. #__________

Please Note: Each class has a different required number of students needed to secure the class. Occasionally classes are cancelled due to low enrollment. Some classes are divided due to high enrollment with a second meeting time option offered. Once registered, you will receive any detailed specifics concerning your class. Classes are held on public school holidays, unless you receive such detailed specifics. Any changes will be determined after the first class meeting. Should a class be cancelled or if you are unable to meet a change, your payment will be refunded in full.

A Medical Form provided by Cocoon Theatre must be completed before the first class, requesting a doctor’s phone number, as well as 3 emergency contact phone numbers of relatives or friends. If you have not received a Medical Form in the mail prior to the first class, please arrive 20 minutes early to finish the paperwork and make sure to bring the above-mentioned phone numbers with you. If you have any questions at all concerning registration or the class itself, contact Cocoon Theatre President, Marguerite San Millan, at 845-876-6470. Please make checks out to Cocoon Theatre. For email communication: msanmillan@aol.com

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