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Center Stages Penguin Project Annie Jr. Interest Form
Please complete the form on behalf of the young person in your care.
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* Indicates required question
Last name of interested participant
*
Your answer
First name of interested participant
*
Your answer
Age of interested participant as of January 6, 2022
*
10 - 14 years old
15 - 21 years old
Parent/guardian/caretaker name (first and last)
*
Your answer
Best contact phone number (parent/guardian/caretaker)
*
Your answer
Best contact email address (parent/guardian/caretaker)
*
Your answer
Is the young person most qualified to be an artist (performer with special needs) or peer mentor?
*
Artist (performer with special needs)
Peer mentor
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