MAINSTAGE Registration Summer 2019
MAINSTAGE PLAYERS: Grades 9 through ADULT (as of 9/2019).
Rehearsals begin June 24th – end July 25th
Performances on Friday, July 26th and Saturday 27th at 7 PM and Sunday, July 28th at 2 PM

THIS FORM MUST BE FILLED BY A RESPONSIBLE ADULT

Actor's First Name *
Your answer
Actor's Last Name *
Your answer
Address *
Your answer
City/Town *
Your answer
Age *
Your answer
Date of Birth Format: xx/xx/20xx *
Your answer
Your grade
as of September 2019
Grade *
CELL Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Relationship *
Your answer
Emergency Phone *
Your answer
*AGE 18 and under - Please add 2nd CONTACT
Parent/Guardian's Name
Your answer
Parent/Guardian's Cell Phone
Your answer
Parent/Guardian's Email
Your answer
MEDICAL RELEASE: I authorize all representatives of Newbury Musical Theatre Company to act in my behalf for the purpose of obtaining emergency medical treatment for the registrant.
Authorization *
In case of an emergency, which hospital do you prefer? *
CONSENT FORM AND LIABILITY WAIVER: I/We, the parents/guardian give our permission for our child to participate in the Newbury Musical Theatre Company (“NMTC”) program and performances, events and/or productions (“production”). I/We also give our permission for NMTC to use the likeness of our child in photographs, advertisements and Social Media related to NMTC or NMTC productions. Names will not accompany any likeness or image. I agree that my child will abide by all rules and regulations reasonably adopted in connection with NMTC, any production and the use of the facilities provided for NMTC programs or productions. I understand that the failure of my child to observe these rules and regulations may result in my child being excluded from the program or from participation in any production. I agree to waive any and all claims of any kind whatsoever, whether resulting from an injury or otherwise, and further agree to release, indemnify and hold the NMTC, its employees, contractors, volunteers, officers, directors, and representatives harmless from and against any and all liability arising out of or relating to my child’s participation in NMTC programs or any production. I further understand that NMTC assumes no liability for lost, misplaced stolen and/or damaged property and I hereby agree to release NMTC from such liability.
PRODUCTION/COSTUME FEES are due in full by June 24th, 2019. You will be considered registered when we receive fee in full. Fees are non-refundable after the program begins. Please make checks payable to: "Newbury Musical Theatre". Call or go to the website to pay by credit card.
EVERY ACTOR is responsible for obtaining TWO quarter page ads or personal messages or pay the equivalent to support the PLAYBILL
In checking the box and entering your name below, you agree to all the above information. *
Required
NAME *
Your answer
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