Form-4

Street Address

City, State, Zip

Phone Number

Indian Performing Arts Company

Your Custom Text Here

SUMMER THEATRE CAMP - 2025

In Collaboration with UNIQ ACADEMY, Coaching Center, BSK, Bengaluru

Batch 1: Age Group: 06 - 10 Years / Batch 2: Age Group: 11-15 Years

VENUE: UNIQ ACADEMY, Master Hirannaiah Road, 9th Main, 24th Cross, Near BATA Showroom, BSK 2nd Stage, Bengaluru-560070

Full Name of the Child

First Name

Last Name

Gender

Date of birth

YYYY

Name of the School

Mother's / Father's Name

Mother's / Father's Phone Number

Alternate Phone Number / Name

Mother's / Father's Email

Address of Residence

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

BATCH

Interests & Hobbies of the child

Any Medical Concern ?

How did you here about us ?

Anything you want to ask / inform us?

KINDLY NOTE - THE FEES PAID IS NON-REFUNDABLE