EMERGENCY CONTACT INFORMATION:  Please print clearly.

Name:_______________________________  Grade:___ Email:__________________________

What are you involved with?(any/all shows, crews, or pit)_________________________

Home Phone: (_____) ____________________  Cell Phone: (_____) ______________________

Parent or Guardian’s Names:______________________________________

Home Address:   _______________________________________________________________        
Home Phone: (_____) ____________________  Email:_____________________
Cell Phone: (_____) _____________________   Work Phone: (_____) ____________________


EMERGENCY CONTACT (If a parent cannot be reached)

Name: ____________________________________ Home Phone: (_____) _________________

Work Phone: (_____) _______________________  Cell Phone: (_____) _______________


Do you have any medical conditions and/or allergies?  Yes/No   If yes, please describe: 

_______________________________________________________________________________________



Can you receive Advil/Tylenol/etc?__________Anything else we should know?________________


PARENTS: Please fill out the following 
Do you give permission for your child’s photo to be used in: 

Newspapers: Yes/No  Website: Yes/No  Other: Yes/No  (programs/promotional materials)

Please check off the area(s) in which you may be available to volunteer:

___ Set Design and Construction                                 ___ Raffle Basket Donation
___ Set Painting                                                ___ Concession
___ Flyer Distribution (stuffing mailboxes)                     ___ Poster Run Driver 
___ Acquiring Donations from Local Businesses                   ___ Attic Sale (Sept. 26th)
___ Prop Search                                                 ___ Ticket Taking/Door Person                                 
___ Raffle Table Set Up                                         ___  Raffle Table Tear Down
___ Food Donations for Special Events		



Parent Signature_____________________________________________________