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The West Side Takes Stage Registration Form
Please Complete, Print, and mail with the application fee of $ 20 (postmarked by 9/5/17)
NAME *
Your answer
Grade *
Required
Home Address: Street, City, Zip Code *
Your answer
School Name *
Your answer
Email *
Your answer
Cell phone Number *
Your answer
Best Way to Contact You? *
Required
Category Entry (Please check the category or categories you are registering for...) *
Musical Instrument Type, Musical Selection, or Composition Played *
Your answer
Painting or drawing in any medium or technique *
Your answer
Vocal: Name of song and Genre *
Your answer
Dance Genre and are you dancing: Solo, Duet, or Group No more than 4) Please include names if it applies *
Your answer
Drama Type Piece *
Your answer
Photography genre *
Your answer
Release Waiver: I hereby certify that all statements made in this application are true and correct to the best of my knowledge and I authorize investigation of all matters contained in this application or data pertinent to my West Side Takes Stage registration form. I acknowledge that any false statements or misrepresentation on this application will be cause for refusal of placement or immediate disqualification. I ,also, agree to grant full permission to the organizers of West Side Takes Stage to use my name and any photographs, videography, motion pictures, or recordings for any purpose whatsoever without any obligation, liability, or compensation to me. (Initial you have read the waiver) *
Your answer
Signature (Participant) *
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Signature Parent/Legal Guardian (If under 18 Yrs. of Age) *
Your answer
Print Name of Parent/Guardian (If under 18 Yrs. of age) *
Your answer
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