subject_line
Student Information
First Name
*
Last Name
*
Gender
*
Male
Female
Date of Birth
*
School
*
Grade during Class Year
*
🛈
K
1
2
3
4
5
6
7
8
9
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
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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:
*
Yes, take my child to Emergency Hospital
No, do NOT take my child to Emergency Hospital
I give permission for my child to receive emergency treatment:
*
Yes
No
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