First Stage Brightmoor Winter/Spring 2019 Ensemble 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. Max M. Fisher and Marjorie S. Fisher Foundation

Rehearsals begin Monday, February 4th
Rehearsals end the week of November April 17th. Showcase Wednesday, April 17th.

Days and Times : Mondays and Wednesdays from 5:30 pm - 7:30 pm
Will take place two days a week after school.
*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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