Audition Workshop Registration Form

Student Information

Students First Name*

Nickname if Preferred

Student's Last Name*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Gender*

Girl
Boy

Age*

Please list what school your child attends

Church Attended (if any)

Parent/Guardian Information

Parent/Legal Guardian's Name*

First Last

Parent/Legal Guardian's Relationship to Child*

Parent/Legal Guardian's Cell Phone*

Parent/Legal Guardian's Home Phone*

Additional Parent/Legal Guardian's Name

First Last

Additional Parent/Legal Guardian's Relationship to Child

Additional Parent/Legal Guardian's Cell Phone

Additional Parent/Legal Guardian's Home Phone

Emergency Contact (Other than the names listed above)*

First Last

Emergency Contact Phone*

List all people, including yourself, approved to pick up your child, Or please indicate if your child will be driving themselves.*

Child's Health Information

Food Allergy*

Yes
No

If yes, please list specific food allergies

List Any Other Medical Conditions (asthma, etc.) or Activity Restrictions

Are all child's shots current*

Yes
No

If no, please explain

Payment

You must submit your online registration by 2pm prior to the Audition Workshop to secure your child’s spot. A separate registration form must be filled out for each student your are registering.

Child's Medical Consent

(I) (We) the undersigned, parent(s)/guardian(s) of the registrant above, a minor, do hereby authorize the adult sponsors of the Foundry Center for the Arts, as agent(s) for the undersigned, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, which is deemed advisable by, and is required to be rendered under the general or special supervision of, any physician or at the hospital or other health care facility. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, and is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which may be determined by a physician or surgeon, as aforesaid, to be advisable in the exercise of his/her best judgement. By typing my name below, I am signing this agreement.

Electronic Signature*

Date*

Crowd Release Notice

This notice serves to announce that filming, taping, and or photography will take place at the Foundry Center for the Arts during the Foundry Audition Workshop. By entering our campus, you grant the Foundry Center for the Arts the right to photograph you and your dependent children, to record your voice and to use your likeness without compensation. You also agree to release the Foundry Center for the Arts from any liability in connection with the taping/video production in perpetuity. Video and still images produced from Foundry events may be used by The Foundry Center for the Arts in print publications (e.g. flyers, brochures) or video productions. Video and still images may be posted to the Foundry Center for the Arts website. By entering the Foundry Center for the Arts campus, you agree to allow your image to be used for these purposes.

Electronic Signature*

Date*

Audition Workshop Registration Form