Camden Ballet TheatreConservatory Audition Pre-Registration Form
Parent / Guardian Information
Parent/Guardian Name:
Email:
example@example.com
Phone:
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Zip:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Dancer 1
Full Name:
Date of Birth:
-
Month
-
Day
Year
Date
Age:
Current Ballet Level:
Years of Dance Training:
Current School/Studio (if applicable):
Medical Concerns/Allergies:
Dancer 2
Full Name:
Date of Birth:
-
Month
-
Day
Year
Date
Age:
Current Ballet Level:
Years of Dance Training:
Current School/Studio (if applicable):
Medical Concerns/Allergies:
Dancer 3
Full Name:
Date of Birth:
-
Month
-
Day
Year
Date
Age:
Current Ballet Level:
Years of Dance Training:
Current School/Studio (if applicable):
Medical Concerns/Allergies:
Emergency Contact
Name:
Relationship:
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Phone:
Format: (000) 000-0000.
Liability Waiver
I understand that participation in auditions and dance activities involves physical activity and carries inherent risks of injury. I voluntarily allow the above-named dancer(s) to participate in Camden Ballet Theatre Conservatory auditions. I release and hold harmless Camden Ballet Theatre, Maine Performing Arts Company, its faculty, staff, volunteers, and facility owners from liability for injuries or losses arising from participation, except where caused by gross negligence or willful misconduct. I certify that my dancer(s) are physically able to participate and authorize emergency medical treatment if I cannot be reached.
Parent/Guardian Signature:
Date:
-
Month
-
Day
Year
Date
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