AUDITION WORKSHOPS

Student First Name: *

Student Last Name: *

Student's DOB (XX/XX/XXXX): *

Student Gender *

Male

Female

Non-Binary

School:

PARENT #1 INFORMATION

Parent # 1 First Name *

Parent # 1 Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Parent # 1 Home Phone

Parent # 1 Work Phone

Parent # 1 Cell Phone

Student's Cell Phone

Parent # 1 Email Address*** This email will be considered the "primary" address and will receive all communications from kidsActing *

PARENT #2 INFORMATION

Parent #2 First Name

Parent #2 Last Name

Street Address

Address Line 2

City

State

Zip Code

Parent #2 Home Phone

Parent #2 Work Phone

Parent #2 Cell Phone

Parent #2 Email Address

Student's Cell Phone

Student's Email Address

Emergency Contact Cell Phone

Does your child have any allergies or physical restrictions we need to know about?