Teatro Mosaico 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 Youth Ensembles introduce Young Artists to Mosaic's brand of high-energy, empowering and inspiring performing arts training. Grades 3-6 (Ages 8-11)

There is no experience Mosaic's bilingual theater program, Teatro Mosaico, will take place at the Ford Resource and Engagement Center 2826 Bagley Avenue, Detroit, MI 48216 . No experience necessary to participate. There is no fee to participate in this program.


Winter Session Rehearsals
Dates: February 6th- April 14th, 2017
Days: Mondays and Wednesdays
Times: 5:00-7:00 PM
Young artists in grades 3-6 (Ages 8-11)

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
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 age
Young artist's school
Your answer
What grade will the young artist enter in the Fall?
Gender
Disability
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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