SPOTLIGHT KIDS ACTING WORKSHOP
PARENT/GUARDIAN CONSENT, LIABILITY WAIVER, AND MEDICAL AUTHORIZATION
Organization: JC Mainstage with Tri County Performing Arts Academy
Location: First Christian Church, 1250 Nyssa St
Dates: June 15–19
Time: 9:00 AM – 12:00 PM
Participant Ages: 9–14
Email *
1. PARTICIPANT INFORMATION
Childs Full name
 *
T shirt size *
Age *
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Name(s)
 *
Phone number *
Email Address *
Emergency Contact Name *
Emergency Contact Phone *
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