First Stage in the Osborn Neighborhood 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 5th-10th, to Mosaic's brand of high-energy, empowering and inspiring performing arts training. Cast members of Mosaic First Stage learn the basics of performance: articulation, projection, movement through high energy games, scenes and monologues. The Program culminates with a showcase for family and friends on the big stage!

No experience necessary to participate. There is no fee to participate in this program.


Fall Session
Dates: February 6th - April 14th, 2017
Days: Mondays and Wednesdays
Times: 4:30-6:30 PM


Young artists in grades 5-10 (Ages 11-14 years)

Location:
Matrix Human Services
13560 McNichols E, Detroit, MI 48205

Young artist's (Student) 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
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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