Student Information

First Name *

Last Name *

Date of Birth *

Gender *

Custom Gender

School *

Grade this coming Fall * 🛈

New/Returning Student *

I am a NEW student to MTW.

I am a RETURNING student to MTW.

Theatre Immersion Level 1: June 12-June 23 - Wait List Only

Theatre Immersion Level 1: July 10-July 21 - Wait List Only

Theatre Immersion Level 1: June 26-June 30 - Wait List Only

Theatre Immersion Level 2: June 26-June 30 - Wait List Only

Theatre Immersion Level 1: July 24-Aug 4 - Wait List Only

Theatre Immersion Level 2: July 24-Aug 4 - Wait List Only

EARLY BIRD PRICES GOOD UNTIL FEBRUARY 28th

MTW reserves the right to require vaccination or weekly testing (in lieu of vaccination) depending on community prevalence of Covid19.

Program *

Introduction to Theatre - Grades K-2: June 12 - June 23, 9am-3pm: $950

Introduction to Theatre - Grades K-2: July 10 - 21, 9am-3pm: $950

Theatre Immersion Level 1- Grades 3-5: June 12 - June 23 9am-5pm: $1050

Theatre Immersion Level 1 - Grades 3-5: June 26 - June 30, 9am-5pm: $550

Theatre Immersion Level 1- Grades 3-5: July 10 - 21, 9am-5pm: $1050

Theatre Immersion Level 1 - Grades 3-5: July 24 - Aug 4, 9am-5pm: $1050

Theatre Immersion Level 2 - Grades 6-9: June 26 - June 30, 9am-5pm: $550

Theatre Immersion Level 2 - Grades 6-9: July 24 - Aug 4, 9am-5pm: $1050

Master Class - Grades 5-9: Aug 7- 11, 9am-5pm: $550

The Master Class is a more intensive workshop for students with previous experience. Please describe your past performance experience.

T-Shirt Size *

All participants receive a T-shirt.

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.

How did you first hear about MTW's summer program? *

If Other, please complete.

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