Opening Act Student Theatre Registration Form
Please fill out this form to register.
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please list your child's preferred snack
Please fill in sizes for costuming purposes.
Rows
Shirt
Pants or skirt
Dress
Shoe
Size
Youth or Adult
School Grade as of September
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to student
*
Contact Phone Number
*
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Relationship to student
*
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Does the student have any allergies or health issues that we should be aware of? What is the preferred treatment?
*
Medical Release: I give consent for QYU staff and/or volunteers to give first aid and/or to seek emergency medical care for my child(ren) if needed. I understand that QYU staff or volunteers will contact me as soon as possible in cases of medical or other emergencies.
*
Yes
No
Does the student have any behavioural or emotional issues we should be aware of?
*
Please check the following boxes if you give consent to Quinte Youth Unlimited staff to post photos of your children for promotional and informational purposes on:
Please check the following if you give permission for Quinte Youth Unlimited to share this contact information in a Team Directory.
Phone Number
Email
Please indicate the payment option that you will be using.
One time Payment
Monthly Payments
Assistance Requested
By submitting this form you are providing consent to Quinte Youth Unlimited to use the personal information provided to deliver its programs and services. If you have any questions about our collection, use, and disclosure of personal information, please refer to our
Privacy Policy
.
*
I agree
Submit
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