Name
*
First Name
Last Name
Age
*
Class
*
Shooting Stars (5-8)
Performing Buddies: (9-12)
Lights, Camera, Action! (13+)
Ages 20 +
Contact Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Mobile Number
*
-
Area Code
Phone Number
Health Info
Health Card No.
Allergies
Special Requirements
Permissions
By signing below I hereby givepermission for images of my child, captures during regular and specialactivities through video/photo, to be used solely for the purpose ofpublication by Shannon Oliver’s Drama Club and waive any rights of compensationor ownership thereto.
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