Upper Canada Academy of Performing Arts

260 Brock Street , Kingston.

St. Mary’s Parish Centre

Registration Form

Surname: ____________________   First Name:___________________

Address:_________________________________________________

Mailing Address:___________________________________________

Phone: _________________  E-Mail Address:_____________________

Emergency Contact:

Name: ________________________  Phone: __________________

Special Accommodation Required?

Voice, Instrumental or Puppet Program:

Area and Courses to be Registered:

Payment Method:  O Cash
O Cheque O Credit Card: __________________

Expiry date: _________

Registration fee of $25. covers application materials

and an Upper Canada Academy t-shirt.

Please send or deliver form to the Academy, 260 Brock St., Kingston, ON K7L 1Y5

Academy Office Notes Below:
________________________________________________________

Studio Assignment: