Primary Contact Name *

First Name

Last Name

Primary Phone Number *

(###)

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Secondary Phone Number *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Phone *

(###)

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Student Name *

First Name

Last Name

Student Date of Birth *

MM

DD

YYYY

I hereby release Curtain Call Performing Arts Company, its contractors and volunteers from all claims for damages arising from any accident or injury which is caused or arises from participation of the applicant during any program. Permission is hereby granted to Curtain Call Performing Arts Company and its representatives to transport my child to a local doctor or hospital via ambulance for medical treatment if necessary. *

I agree

Media Consent; I give permission for photo and video footage that my child may appear in to be used for promotional purposes. *

Yes, I give media consent

No, I do not give media consent

Students must attend all mandatory rehearsals, tech week rehearsals and all performances. There will be no exceptions. *

I understand

I have reviewed your Terms of Service and Private Policy and agree and understand all that is listed. *

I understand