DEPARTMENT OF COMMUNICATIONS

Theatre Program

Students should come to the workshop with a 2- to 3-minute memorized monologue.

First Name:	Last Name:	Age:	Gender:

Parent/Guardian Name:	High School/Affiliation:	2012-2013 Classification:

Home Phone:	Cell Phone:	Email:

Address:	City:	State:	ZIP:

Do you have any special needs?

I give my permission for to receive emergency medical treatment.

In an emergency, please contact:
Name:	Phone:

Parent/Guardian Signature: Typing your name in this field will serve as your signature.		Date:

Note: Registration is limited to the first 30 people to sign up. You will be notified by email for confirmation.