8/26 Improv Theatre night

ASPIRE Center for Learning and Development
Improv Theatre and Pizza Night

Ages:

13-18 years old

Date/Time:

Wednesday, August 26, 2015

6:00pm-7:30pm

Location:

ASPIRE Center "The Garden"

2562 New York Avenue

Melville, NY 11747

Recreation Fee:
$35

Facilitator:

Samantha Maietta, LMSW
Attendee Name
Attendee DOB

MonthDayYear
Parent(s) Name
Home Address
Primary Phone Number

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
E-mail Address
Allergies or Medical Concerns
Cash or Check - postal mail*Cash or Check - in person*
By clicking "submit," you are indicating consent for your child's attendance at this event and responsibility for recreation fee listed above.
Should be Empty:

ASPIRE Center for Learning and Development