Nutcracker 2017
If the dancer is under the age of 18 this form must be filled out by a parent.
Dancer's Last Name
Your answer
Dancers First Name
Your answer
Dancer's Birth Date
MM
/
DD
/
YYYY
Dancer's Age
at time of audition
Mothers Name:
Your answer
Fathers Name:
Your answer
Address:
Your answer
City:
Your answer
Zip Code:
Your answer
Primary Telephone:
Please include area code
Your answer
Additional Telephone:
Your answer
Primary Email Address:
Your answer
Additional Email Address:
Your answer
What academic school do you attend?
Your answer
Do you currently study ballet?
Where do you study ballet?
Years of ballet training:
How many days of ballet training per week?
How long on pointe:
Have you performed with PTB before?
If Yes, what recent Ballet?
List other performance experience within the last 2 years:
Your answer
How did you hear about PTB?
Your answer
Height in inches:
Your answer
Each cast family of a minor age dancer agrees to contribute a minimum of approximately 20 service points (service hours) toward the production. I understand that all required service hours must be completed before a performer will be allowed to audition for a subsequent production.
I agree to provide refreshment concession items as specified in the audition information. If I do not deliver these items, I will be billed $25
I give my permission to share this information with members of the cast to use conducting Placer Theatre Ballet business
I give my permission to be video taped and/or photographed by Placer Theatre Ballet or its affiliates, including clients, licensees, purchasers, agencies, periodicals, and television media, the irrevocable right to use by name and photographs or video in which I may appear, for sale and/or reproduction in any medium for purposes of advertising, trade, display, exhibition or editorial use. I have read this release and fully understand its contents.
I am the parent or legal guardian of the above named minor and hereby approve the foregoing and consent to the photograph/video use, subject to terms mentioned above.
I hereby release and discharge Placer Theatre Ballet, its staff, representatives, and affiliates, from all liability arising out of, or in connection with, participation during rehearsals at the Conservatory of Dance, 4561 Pacific Street, Rocklin, CA and performances at Placer High School Theater, Auburn, CA.
By submitting this form, I understand that Placer Theater Ballet is released from all liability.
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