2017 Summer Registration
This registration is for Showstoppers' 2017 Summer Teen Ensemble Les Mis
Actor's First Name
Your answer
Actor's Last Name
Your answer
Actor's Date of Birth
MM
/
DD
/
YYYY
School Actor Attends
Your answer
Gender
Home Address
Please include house or apartment number, and street name
Your answer
Zip Code
Your answer
Actor lives with
Name of person registering this actor (First parent or guardian)
Please give us your name
Your answer
What is your phone number?
Phone number we would call to speak to you.
Your answer
What is your email address?
Please give us the best email to communicate about this session of Showstoppers
Your answer
Second parent or guardian's first and last name
Your answer
Phone number of 2nd parent or guardian
Your answer
Email address of 2nd parent
Enter only if this person would like current information about this session.
Your answer
Emergency Contact
used only if the people listed above cannot be reached
Your answer
relationship to actor
Your answer
This person's phone number
Your answer
Medical Insurance Company
Your answer
Insurance Policy Number
Your answer
Actor's doctor or medical group
Your answer
Phone number of doctor or medical group
Your answer
If your child has a medical emergency or accident, what should be done?
You, and others listed will be called first. Give as much guidance as you can.
Your answer
Please list any medical conditions, or special needs we should be aware of.
Your answer
Is special equipment or skill needed to deal with this?
Your answer
What is your name?
Your answer
Are you
Do you or another member of your family wish to volunteer for jobs during rehearsals or performances?
How do you intend to pay tuition?
Mailing address and link to mail online will be emailed to you.
Do you confirm that all information provided by you is correct and complete?
Do you understand that enrollment is not complete until payment has been made?
Electronic Signature
By checking "I agree" I affirm consent, and agree that: My electronic signature on this form above the same effect as if I signed this form in ink.
Your answer
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