Child's Name *

First Name

Last Name

Custodial Guardian's Name *

First Name

Last Name

Phone

(###)

###

####

Emergency Contact's Phone

(###)

###

####

Date

MM

DD

YYYY

Would you like to join our eClub and receive information about upcoming events at the Columbia? (Relax! Your email is safe with us! We will only send you Columbia Theatre news and will never give your information away for any reason!) *

Yes! I would like to get info about upcoming events at the Columbia Theatre

No Thank You