Student Information

First Name *

Last Name *

Gender *

Male

Female

Date of Birth *

School *

Grade during Class Year * 🛈

New/Returning Student *

I am a NEW student to MTW.

I am a RETURNING student to MTW.

MAIN STAGE - WAIT LIST ONLY

Program *

Main Stage Performance Company, Wednesdays, 4 - 5:30pm, $695

Cabaret Company, Thursdays, 4 - 6pm, $450

Gotta Sing Gotta Dance #1, Grades K-1, Tuesdays, 4 - 5pm, $295

Gotta Sing Gotta Dance #2, Grades 1-2, Tuesdays, 5 - 6pm, $295

Broadway Bound #1, Grade 3, Mondays, 4 - 5:30pm, $315

Broadway Bound #2, Grades 4-5, Mondays, 4 - 5:30pm, $315

Voice Training for Musical Theatre, Thursdays, 4 - 5:30pm, $315

Permission to Photograph *

Yes - My child has my permission to be photographed or videotaped, while participating in MTW classes or performances, for possible use in informational or marketing material in any medium for the purposes of promotion, fundraising, marketing, documentation and public display.

No - My child does not have my permission to be photographed or videotaped, while participating in MTW classes or performances, for possible use in informational or marketing material in any medium for the purposes of promotion, fundraising, marketing, documentation and public display.

Family Information

PRIMARY CONTACT INFORMATION

Primary Phone *

Primary Email Address *

Street Address *

Address Line 2

City *

State *

Zip Code *

PARENT 1 CONTACT INFORMATION

Parent 1: First Name *

Parent 1: Last Name *

Check if person is an emergency contact

Yes, contact in an emergency

Parent 1: Phone *

Parent 1: Email Address *

Parent 1: Employer & Title/Position

Street Address (if different from above)

Address Line 2

City

State

Zip Code

PARENT 2 CONTACT INFORMATION

Parent 2: First Name

Parent 2: Last Name

Check if person is an emergency contact

Yes, contact in an emergency

Parent 2: Phone

Parent 2: Email Address

Parent 2: Employer & Title/Position

Street Address (if different from above)

Address Line 2

City

State

Zip Code

Emergency Information

Person(s) to Notify in an Emergency (in addition to ones checked above)

	Name	Phone Number	Relationship
#1	Name	Phone Number	Relationship
#2	Name	Phone Number	Relationship
#3	Name	Phone Number	Relationship

Child's Doctor *

Phone Number *

Action to be taken (for major illness/injury) if parent cannot be reached: *

I give permission for my child to receive emergency treatment: *

Does your child have any food/drug allergies? If YES, please describe.

Does your child take any medications? If YES, please describe.

Besides parents/guardians the following people have permission to pick up my child from MTW:

	Name	Phone Number	Relationship
#1	Name	Phone Number	Relationship
#2	Name	Phone Number	Relationship
#3	Name	Phone Number	Relationship