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RDC Emergency Contact Form - 2024
This form MUST be completed by the first day of rehearsal, either
Sept. 21 or Oct.5 determined by casting.
Please e-mail dancewithrdc@gmail.com any time during the production of the Nutcracker - Clara's Dream if you have any questions or concerns.
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* Indicates required question
Dancer's Name
*
Your answer
Dancer's phone number, if applicable
Your answer
Dancer's Birth Date
*
MM
/
DD
/
YYYY
Dancer's Home Address
*
Your answer
Emergency Contact Name (Adult 1):
*
Your answer
Emergency Contact Cell Phone (Adult 1):
*
Your answer
Emergency Contact Home Phone (Adult 1) (if applicable)
Your answer
Emergency Contact Work Phone (Adult 1) (if applicable)
Your answer
Emergency Contact Name (Adult 2):
*
Your answer
Emergency Contact Cell Phone (Adult 2):
*
Your answer
Other adult emergency contacts (name and phone number)
Your answer
In the case of an emergency, I give permission for my information to be released to emergency personnel. I also agree that any of the contacts listed may be notified in an emergency, as needed.
*
Yes
No
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