Theater Studio ApplicationFirst Child InformationChild's First Name *Child's Last Name *Child's Name in Russian *Preferred Name Date of birth *mm/dd/yySchool and Grade Knowledge of RussianSpeaking *Reading *Writing *Food Allergies Please specifySecond Child InformationChild's First Name Child's Last Name Child's Name in Russian Preferred Name Date of birth mm/dd/yySchool and Grade Knowledge of RussianSpeaking Reading Writing Food Allergies Please specifyParent/Guardian InformationFamily *please selectBoth parents are Russian-speakingMixed familyNon-heritage studentParents/Guardians' Names *Parents/Guardians' Email *Parents/Guardians' Cellphone *Parents/Guardians' Other Phone *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmergency Contact *Name and contact information in case of emergencyPersons Authorized to Pick Up Child *Name, contact information. and relation to childProgram InformationSelect a Program *Other KIDZHOME programs and the After-School Program have separate application forms. They can be found under Registration.Full Program (Drama, Russian, Arts and Crafts/Music)Partial Program (Just Drama)Partial Program (Drama and Russian)Partial Program (Drama and Arts and Crafts)Please select if your child is already our student in another program This is important for calculating discounts.After-School ProgramOther KIDZHOME programIf you selected Other KIDZHOME program above, please specify Payment Method *Pay with ZelleCheckCashChase QuickpayVenmoHow did you learn about us? Comments Important information about your child that we should know. All information will be kept strictly confidential.Signature *By signing this application I permit CEKPET Ltd. to take pictures/videos of my child(ren) and publish them on its websites and Facebook page, as well as in its publicity materials. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: