First Stage Brightmoor Fall 2017 Registration Form
Mosaic Youth Theatre of Detroit's mission is to empower young people to maximize their potential through professional performing arts training and creation of theatrical and musical art that engages, transforms and inspires.

Mosaic's First Stage Programs introduce Young Artists, grades 5-10, to Mosaic's brand of high-energy, empowering and inspiring performing arts training.

First Stage Brightmoor Neighborhood
Location: Leland Community Affairs Inc. 22420 Fenkell Detroit,MI
Ages: 11-14
Cost: No fee. Skillman 100% scholarship
Dates: September - November
Days:Tuesday's & Thursdays
Times: TBD
*First Stage Brightmoor is home to our First Stage Choir and First Stage Brightmoor Acting program.

Young artist's last name
Your answer
Young artist's first name
Your answer
Young artist's street address
Your answer
Young artist's city of residence
Your answer
In which First Stage program will your young artist participate?
Young artist's state of residence
Your answer
Zip Code
Your answer
Young artist's home phone number
Your answer
Young artist's email address
Your answer
Young artist's date of birth (MM/DD/YYYY)
Your answer
Young artist's school
Your answer
What grade will the young artist enter in the Fall?
Gender
Young Artist Age
Disability
How did you hear about Mosaic?
Race (Please select all that apply)
Required
Major Cross streets
Your answer
Side of town
Your answer
Parent/ Guardian name (Last, First)
Your answer
Parent / Guardian street address
Your answer
Parent / Guardian City
Your answer
Parent / Guardian State
Your answer
Parent / Guardian Zip Code
Your answer
Home Phone
Your answer
Cell phone
Your answer
Work Phone
Your answer
Parent / Guardian email address
Your answer
Employer
Your answer
Primary Lauguage
Relationship to young artist
Parent / Guardian 2 Name (Last, First)
Your answer
Parent / Guardian 2 street address
Your answer
Parent / Guardian 2 state
Your answer
Parent / Guardian 2 Zip code
Your answer
Parent / Guardian 2 Home Phone
Your answer
Parent / Guardian 2 Cell Phone
Your answer
Parent / Guardian 2 Work Phone
Your answer
Parent / Guardian 2 Email Address
Your answer
Parent / Guardian 2 Employer
Your answer
Parent / Guardian 2 Primary Language
Relationship to young artist
Emergency Contact Person 1 Name (Last.. First)
Your answer
Emergency Contact Person 1 Telephone Number
Your answer
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