KidStage Registration Form

Creating experiences people never forget!

Performing Arts Center on the Square

Name___________________________________________________________________________

 

Age_________________ Grade (2009-10 school year)____________________________________

 

Parent/Guardian___________________________________________________________________

 

Address_________________________________________________________________________

 

Phone Numbers___________________________________________________________________

 

If parent/guardian cannot be reached, in case of emergency call 

 

_______________________________________________________Phone___________________

 

Previous theatrical training or experience:

 

 

 

Special talents or skills:

 

 

 

Please check one of the following statements:

 

_____Center on the Square has my permission to use my child’s photo 

(photo only, no name or other identification) for newspaper and Internet press

release purposes.  

 

_____Center on the Square does not have my permission to use my child’s  photo

(photo only, no name or other identification) for newspaper and Internet press

release purposes.

 

Size for free t-shirt:  Youth                        SM_____  MED_____ LG_____

 

                                  Adult                        SM_____  MED_____ LG_____

 

 

Parent/Guardian Signature___________________________________     

 

 

For Office Use:

Payment Information _______________________________