Student Information

First Name *

Last Name *

Date of Birth *

Gender *

Custom Gender

School *

Grade during Class Year * 🛈

New/Returning Student *

I am a NEW student to MTW.

I am a RETURNING student to MTW.

Program (Choose Waitlist if desired program is full, and then specify the desired Waitlist) *

Waitlist *

T-Shirt Size *

All participants receive a T-shirt.

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

MTW is committed to providing Financial Assistance and grants it on the basis of need. Click this link to download a financial assistance application.

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.

Student/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

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

	Name	Phone Number	Relationship
#1	Name	Phone Number	Relationship

Does your child have any food/drug allergies, take any medications, or have any existing medical conditions that we should be aware of? If YES, please describe.

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Please provide the names and relationship of any additional people who have permission to pick up your child from MTW:

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