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Libertyville Broadway Bound: Willy Wonka Kids
Rehearsals
Tuesdays and Thurdays 6:00 - 7:30pm
IP Blackbox Theatre - 735 N Milwaukee Ave, Libertyville, IL 60048
New Student
Student's Name (First, Last): *
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Student's Age:
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Parent/Guardian (First, Last) (*if guardian, please include your relationship):
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Parent's/Guardian's Primary Phone Number:
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Parent Guardian's Secondary Phone Number:
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Parent/Guardian's E-mail:
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Emergency Contact Name:
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Emergency contact Relationship to Student:
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Emergency Contact's Secondary Phone Number:
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Please list all student allergies and necessary medical supplies i.e. EPI-Pen etc. (even minor allergies, better safe than sorry!): *
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Please list any/all medical information or behavioral health information for your student: *
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Please provide your mailing address below:
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Any other questions or concerns you would like to make the IP Staff aware of? Please let us know! We are happy to read and help answer any necessary questions/concerns/comments.
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T-Shirt Size (Youth Sizes)
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