Chapter 21 – Performer Registration Form
Please complete this form to register your child for the anniversary production and provide necessary details.
Student Information
Student Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Age
*
Parent/Guardian Name
*
First Name
Last Name
Mobile
*
-
Area Code
Phone Number
Email
*
example@example.com
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship to Performer
*
Please Select
Parent
Guardian
Grandparent
Other
Emergency Contact Phone Number
-
Area Code
Phone Number
Medical Information
Does the performer have any allergies?
*
Yes
No
If yes, please list the allergies and any reaction details.
Does the performer have any medical conditions?
*
Yes
No
If yes, please describe the medical conditions and any important details.
Does the performer take any medication that we would need to administer at the Theatre?
*
Yes
No
If yes, please list the medication names, dosage, and any relevant instructions.
Additional Support
Does the child require special assistance?
*
Yes
No
If yes, please describe the assistance or accommodations needed
Fit to Perform
I confirm my child is fit to participate in the performance Chapter 21
*
Confirmed
I agree to notify Paris Performing Arts of any changes to my child’s health or fitness to perform
*
Agree
Anniversary T-Shirt Order
Would you like to order a 21st Anniversary T-shirt?
*
Yes
No
T-shirt size
Please Select
Age 5–6
Age 7–8
Age 9–11
Age 12–13
Adult S
Adult M
Adult L
Adult XL
Chaperones
Interested in helping backstage?
*
Yes
No
Do you hold a current chaperone licence?
*
Yes
No
Chaperone licence number
Issuing Local Authority
Photography & Video Consent
Photography Consent
*
I agree to photography for promotional and documentation purposes.
Video Consent
*
I agree to video recording for promotional and documentation purposes.
PPA Memory
What is your child's favourite PPA memory so far?
What does being part of PPA mean to your child or family?
Is there a teacher, moment, performance, or achievement that has been especially special?
Parent Consent
*
I understand that rehearsals are an important part of the production and will make every effort to ensure my child attends all classes and scheduled rehearsals leading up to the show.
Show Fee
*
I have paid the Show Fee of £25 which is non-refundable using the following link: monzo.com/pay/r/paris-performing-arts_CpgfeUG5fM4Kut
Signature
*
Submit
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