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Web Site Warrick County Summer Musical Parent Authorization Form Student Legal First Name * Student Middle Name Student Last Name * Student's Date of Birth * Home Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZipCode * County Warrick Vanderburgh Posey Spencer Henderson Gibson Webster Other Home Phone * Student Mobile Phone * Gender * Male Female Neutral Parent/Guardian 1 - Name * Parent/Guardian 1 - Email * Parent/Guardian 1 - Best Contact # * Parent/Guardian 1 - Relationship to Student Parent/Guardian 1 - Employer Parent/Guardian 2 Parent/Guardian 2 - Email Parent/Guardian 2 - Best Contact # Parent/Guardian2 - Relationship to Student Parent/Guardian 2 - Employer Emergency Contact Information Emergency Contact (First Last) * Relationship to student * Emergency Contact Phone Number Medical Information Note any medical conditions, special needs, allergies, etc. * Current Prescriptions * Hospital Preference * Insurance Provider * Insurance Policy Number * Physician Name * Physician Phone Number * Dentist Name * Dentist Phone Number * Authorization Do you grant treatment, participation and media authorization for your student? * Yes No Electronic Authorization (Type first 4 letters of your last name and 2 digit month and 2 digit year of your birth -- SMIT0259) * Full Name of Authorizer * Relationship to student * Parent Participation and Volunteer Request Section We need assistance from parents to help take the burden off the students and staff. Volunteers help make this program successful. Your support is needed and necessary if your child is a part of this program. Rehearsal Concessions (2-3 adults each rehearsal for approx. 45 min) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Show Concessions (4-6 adults per performance during intermission and after show) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Company Meals (2-4 adults during the final week of rehearsals) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Director Meals (1-3 families providing meals for directors during each rehearsal) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Sponsorship, Advertising and Marketing (assisting with developing sponsor relationships, donations, program creation, etc) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Publicity (poster distribution, flyer distribution, postcard stamping, etc) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Ticket Selling (2-4 adults 4:30 - 7:15 each rehearsal) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Selling Tickets During Performances (2-4 adults per performance) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Costuming (cutting patterns, sewing, hemming, altering, ironing, etc) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Set Construction (building, moving, painting, etc) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Scenic Painting (painting scenes on backdrops) * Yes and I wish to be the parent leader for this category Yes and I have contacts that may be able to assist with this portion of the program Yes, I will volunteer No, I'm not able to volunteer in this category Please let us know any additional information that may help with support of our program. Please be advised: When you hit submit, it takes a few seconds to send the form. Please only hit submit once.