2016 Performer Registration - Both parts

2016 SPECTRUM PERFORMER REGISTRATION - Part 1

* Indicates required field

Performer Name *

First

Last

Age *

School *

Grade or level *

Parent/Guardian name (1) *

First

Last

Email (1) *

Home phone Number (1) *

Alternative Phone Number (1) *

Phone Number during Spectrum Project time (1) *

Address (1) *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian name (2) *

First

Last

Email (2) *

Home Phone Number (2) *

Alternative Phone Number (2) *

Phone Number during Spectrum Project time (2) *

Address (2) *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Relationship *

Please explain why you believe your child would enjoy being part of the Spectrum Project.

Why Spectrum? *

Schedule conflicts *

Please look over the calendar schedule and list any conflicts that you may have.

SCHOLARSHIPs:

There are need-based scholarships available to financially assist families with the Spectrum Project tuition. Please indicate here if you would like to apply for a need-based scholarship.

Choose One *

Yes, I would like to apply for a need-based scholarship No, I am not applying

Video and media Release: Students may be videotaped, photographed or audio recorded periodically for educational and promotional purposes. If this media is shared with another party, your child’s name will not be used. Any use of your child's image in the project website will not include last name.

I have read the above statement and will allow my child to be videotaped, photographed or audio recorded periodically for educational and promotional purposes *

I agree I disagree

Next [to Part 2]

2016 STUDENT Performer Registration

2016 SPECTRUM PERFORMER REGISTRATION - Part 1

SCHOLARSHIPs: