EmailMe Form - Summer Theatre Workshop Application

Participant Information
Enter the information below for the workshop participant.
Name *
First Last
Gender
Female
Male
Other/Prefer Not to Disclose
Age *
Address *

Street Address City State / Province / Region Postal / Zip Code
Email *
Phone *
### - ### - ####
School Attending: *
Please list any allergies or medical conditions. *
T-shirt Size *
Parent/Guardian Information
Please submit contact information for the participant's parent/guardian.
Name *
First Last
Address (if different from participant)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Cell Phone *
### - ### - ####
Email *
Applicant Information
We want to know more about the participant!
Theatre Experience
Please list participant's theatre experience in the space above. Include the producing organization, your role, and dates. If you prefer to attach a resume and/or headshot, you can do so at the end of the application. (No experience is necessary.)
Musical Experience
Please list the participant's experience with music, including whether they play an instrument, whether they sing, and how many years of experience they have. Again, no experience is necessary.
What areas of theatre interest you?
Acting
Choreography
Directing
Scene Design
Lighting Design
Singing
Composing Music
Playwriting
Costume Design
Sound Design
Other
Would you like to be considered for a need-based scholarship?
Yes
No
How did you hear about the Summer Theatre Workshop?
Centralia College Website
Facebook
Instagram
Word of Mouth
Other
Upload Your Photo/Headshot (Recommended)
Upload Your Resume (Optional)
Consent to Photograph/Video *
Yes, my child can be photographed/recorded.
No, please pull my child aside if photographs/videos are being taken.
I hereby consent to and authorize the use and reproduction by Centralia College, or anyone authorized by Centralia College, of any and all photographs, including digital images and videos that have been taken of me and that might be used by the College, without compensation to me.
All digital images and prints are owned by the College. The College reserves the right to use these images in any of its print or electronic publications.
I hereby acknowledge that I am 18 years of age or older, or that I am the legal parent or guardian of the named individual and have read and understood the terms of this release.
Parent or Guardian Signature *
Clear

Participant Information

Parent/Guardian Information

Applicant Information