A.I.A.P.D/ A.I.A.P.A

Performing Arts Studio

Join Us

Angels in America of Performing Arts (Pre-Application)
        Application Fee $25

Name:______________________ Email:_______________ Phone:__________ D.O.B:____
Address:______________________ City:_________________ State:________ Zip:______
How many children are you enrolling in this program?_____ # of Boys:____ # of Girls:____
Do your children have permission to travel?______  Have you ever enrolled here before:____ Do your children have permission to participate in single/group pictures?________________
Parent Name:__________________ Phone:________________ Email:__________________
Is your child/children allergic to any foods?__________________________________ 
How did you hear about the A.I.A.P.A?_________________ What payment plan will you be picking?__________________ see: http://angelsinamericaofperformingarts.webs.com
Will you be paying by debit/credit card? Yes/No
If so please provide the details below:(Billing Information)
Name on Card:__________________ Address:________________ City:________ State:___
Zip:_________ Card Number:______________________________    3 DIGIT#______
Email:_______________ Phone:________________Exp:__________ 
Recurring Payments? Yes___ No___

Do the A.I.A.P.D/A.I.A.P.A have permission to charge your credit/debit card in the amount of $25 USD? Yes___ No___

If you have selected recurring payments only. Do you give the A.I.A.P.D/A.I.A.P.A permission to charge your credit/debit card in the chosen plan monthly amount you have picked upon enrolling in this program? Yes___ No___

Sign:_____________________ Date:___________ Time:________ 

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