First Stage Eastern Market 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 Eastern Market Neighborhood
Location: Mosaic Youth Theatre of Detroit 2251 Antietam Detroit
Ages: 7-11
Session 1 Cost: $165
Session 1 Dates: Saturdays, September 16th -November 18th

Session 2 Cost: $180
Session 2 Dates: February-April
Days & Times: Saturday 10am-12pm
*First Stage Eastern Market is home to our First Stage Eastern Market acting program which includes some music.

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
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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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