5th Annual Music, Theater, and Health Institute Registration Form
Directions: Please fill out the following Registration & Medical/Diet Forms. The medical questions should be answered by a parent or guardian. Thank you!
Email address
Name
Your answer
Grade Attending in the Fall
Your answer
Age
Your answer
Address
Your answer
Phone
Your answer
Emergency Contact Number
Your answer
School
Your answer
Emergency Contact Name
Your answer
Relationship to Student
Your answer
Registration Fee Includes: breakfast, lunch, snacks, and all workshop materials and activities
Your answer
Payment Options:
(1) Mail Check or Money Order payable to Monet Cares (2) Credit/Debit Card using Paypal email info@monetcares.org (3) To sponsor a child and/or donate to our scholarship fund, send your donation payable to Monet Cares, a 501 (c)(3) nonprofit organization, and put "Scholarship Donation" in the memo.
Required
Interests:
Check all that apply
Required
Do you have a smart phone?
Required
What do you want to be when you get older?
Your answer
What do you love most about yourself?
Your answer
Do you have any experience within the performing arts? If so, which art form and how much?
Your answer
Why are you interested in the Institute?
Your answer
How did you hear about us?
Your answer
Medical and Dietary Restrictions
To be filled out by Parent or Guardian
Your answer
Any known food allergies ?
Required
If yes, which ones?
Required
Does your child have any special dietary requirements or restrictions?
Required
Does your child have any of the following medical conditions?
Required
Does your child have any allergies to any medications?
Required
Any other health related information that we should know?
Your answer
Please complete the captcha before submitting the form.
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