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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

ZipCode

County

Home Phone

Student Mobile Phone

Gender

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)

Show Concessions (4-6 adults per performance during intermission and after show)

Company Meals (2-4 adults during the final week of rehearsals)

Director Meals (1-3 families providing meals for directors during each rehearsal)

Sponsorship, Advertising and Marketing (assisting with developing sponsor relationships, donations, program creation, etc)

Publicity (poster distribution, flyer distribution, postcard stamping, etc)

Ticket Selling (2-4 adults 4:30 - 7:15 each rehearsal)

Selling Tickets During Performances (2-4 adults per performance)

Costuming (cutting patterns, sewing, hemming, altering, ironing, etc)

Set Construction (building, moving, painting, etc)

Scenic Painting (painting scenes on backdrops)

Please let us know any additional information that may help with support of our program.