Registration Form - Recovery Theatre - Hilltown Youth Theatre

Recovery Theatre Registration

Which HYT Recovery Theatre Weekend are you signing up for?*
- Summer Week (see website for dates)
- Fall Weekend (see website for dates)
- Winter Weekend (see website for dates)
- Spring Weekend (see website for dates)
If you choose more than 1, please enter the number of weekends to the quantity field below to enter the correct payment. Thanks!
Would you be interested staying through for the 3 week Summer Workshop/Spectacle?
Student Name*
First Last
Date of Birth*
Primary Phone
Email
- Receive updates and monthly newsletters?
Primary Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- I am of legal age and do not have a legal guardian:
Parent or Legal Guardian Contact Information: (if applicable)
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Emergency Contact Information:*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Any allergies we should know about?*
1) Tell us a little about your healing journey—e.g., experiences in therapy (conventional and alternative modalities), medications, the types of challenges you’ve had to overcome (anxiety, addiction, trauma, depression, self-harm, eating disorders, etc.)
2) Tell us about one of your successes or what we call "sparkling moments” when you felt like you were making headway in your recovery...It could be a time you did everything you always do and experienced what we call a "unique outcome” or a time you took a completely new approach with positive results.
3) Tell us about an approach or experience in treatment that was not helpful to your recovery…Can you say why you felt it wasn't useful?
4) Please list the names and contacts of anyone who has helped you face these challenges who you think might be useful for us to speak with. (This could be therapists, MD’s and social workers but please don’t limit yourself to clinicians—e.g., it could include teachers, coaches, performing arts and circus instructors, friends, family, etc.)
How will you be paying for the Recovery Theatre Weekend Intensive?*
If paying cash or check, it will be due the week prior to when event/workshop begins. Thanks!
HYT Recovery Theatre Weekend Intensive*
Price: $200.00 Quantity:
Name
This field is for validation purposes and should be left unchanged.

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