2026 Missoula Children's Theatre Preregistration and Permission Slip

PERMISSION and REGISTRATION FORM

Missoula Children's Theatre

at The Liberty Theater in Dayton WA

ALADDIN August 3-8

Child's Name

Age

Grade

Address

Phone

Format: (000) 000-0000.

Email address for communications

example@example.com

1. Parent/Guardian name

Parent/Guardian Phone

Format: (000) 000-0000.

Other emergency contact person 1

Other emergency contact Phone 1

Format: (000) 000-0000.

Other emergency contact person 2

Other emergency contact Phone 2

Format: (000) 000-0000.

Allergies and Medications

Other Special Needs

Physician Name and phone number

WORKSHOPS (optional)

Please check all that apply.

I grant to The Liberty Theater, its representatives and employees, permission to take photographs/videos of my child/children in connection with the above-identified production/event. I authorize The Liberty Theater, its assigns and transferees to use and publish the same in print and/or electronically. I agree that The Liberty Theater may use such photographs with or without identification by name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.

(Note: if you do not give all 3 permissions, we may need to contact you to figure out what other arrangements can be made. We have plans to photograph and video a performance.)

Parent/Guardian: Please print or type your name here

Parent/Guardian Signature (please make a reasonable effort)

Date

--If you fill out and submit the regisration form online, printing is optional.

--If not completed and signed here online, please bring the completed and signed form to the theater, or email to missoulachildrens@libertytheater.org

--Or you can register in the theater lobby Tues. July 28 or Fri. July 31 from 2-5 pm