PEAK Black Heritage Celebration Student Performance Registration Form
PEAK is looking for Pottstown students from Pre-K through 4th grade to perform and showcase their talents focusing on Black Culture or Black individual/s of impact. Due to time limits, a maximum of 5 performances will be chosen after all forms have been received by February 12, 2018. All student performers will be required to attend the Black Heritage Celebration on Saturday, Feb. 24, 2018, from 1 to 3:30 p.m. at the YWCA Tri-County Area gym, 315 King St., Pottstown with an adult. FREE meal and a FREE gift for every child attending will be included.
Student Name(s): *
Your answer
School or Program Site of Student(s): *
Your answer
Grade/Age of Each Student: *
Your answer
Parent/Guardian Name: *
Your answer
Parent/Guardian Contact #: *
Your answer
Parent/Guardian Email Address:
Your answer
Please indicate type of performance the student(s) will perform: *
Name of Performance: *
Your answer
Please explain how the student performance has a focus on Black heritage/culture or provide the name of the Black individual, past or present that the performance is about: *
Your answer
Equipment that will be used during the student performance: *
How long will the performance be? (Performances should be no longer than 5 minutes) *
Your answer
PEAK Black Heritage Celebration Student Performance Rules
• Students must be in Pre-K through 4th grade in the Pottstown School District
• Performance must have a Black heritage focus such as on history or culture or focus on an individual, group or
organization of impact
• Performance can be no longer than 5 minutes
• Each individual performance can be made up of 1 to 5 students
• Must return registration form by February 12, 2018
• NO Profanity
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