Youth Registration Form - Muncie Civic Theatre

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Muncie Civic Prelude Summer Program Registration Form - Formstack

Muncie Civic Summer Preludes Camp Registration

Please fill out all the fields below completely.

Your student's spot will not be secured until you complete payment or fill out a scholarship request.

After registration, you will receive an email with payment/scholarship information.

Student Name (Please use your child’s preferred name. This is the name we will use on nametags, programs, and other publications)*

First Name

Last Name

Student Gender/Pronouns: *

(This information helps us prepare materials for auditions.)

Student Grade Level - for 2023-2024 School Year*

Program (Camp) Student is registering for*

WAIT LIST Dragons Love Tacos Option A (June 12-16: 9-noon) Dragons Love Tacos Option B (June 19-23: 9-noon) Finding Nemo Ensemble Option A (July 10-14: 9-llam) Finding Nemo Ensemble Option B (July 10-14: 5:30-7:30pm) Finding Nemo Ensemble Option C (July 17-21: 9-llam)

May choose one Dragons Love Tacos and one Finding Nemo Ensemble.

Student Picture*

No File Chosen

File uploads may not work on some mobile devices.

Please upload a recent headshot of your child

T-Shirt Size*

For Costuming Purposes

Guardians' Names*

First & Last Name

Guardian Email*

This email will be used for all Civic communication. Including the Final Registration Step, which is to complete payment. Please make sure it is one you check often

Additional Guardian Email - If desired

This email will be used for all Civic communication, please make sure it is one you check often

Guardian Contact Phone Number*

Additional Guardian Contact Phone Number

Emergency Contact Number*

Please provide a second number to be contacted in case of emergencies.

Please list any conflicts you may have during camp or the rehearsal process. *

Camp dates are listed. Please see website for dates regarding extra rehearsals for Finding Nemo. Must be available August 4th, no exceptions.

Medical Information

List any Medical Conditions or Potential Dangers we should be aware of (include allergies and medicine needed here.)*

Inclusion Information

List any other items our team should be aware of to ensure your child's success in our program (include learning disabilities, triggers, etc. here.)*

Media Release Statement

As a non-profit community theatre, we rely on social media and other marketing materials to share the great things our program is doing in the community. Please let the education director know if you want your child to opt out of any marketing materials social media.*

I have read the media release statement.

Demographic - Information

Muncie Civic Theatre's Youth Education program is significantly funded through grants. Consider providing your information here, so that the theatre may provide accurate information to those providing funds. This information will be used solely for grant writing purposes and will not be shared with our theatre volunteers.

School Attending

Home Zip Code

County of Residence

Race

Annual Household Income

Once this form is submitted, you will receive an email regarding payment or scholarship information. Your child's slot will not be secured until payment or scholarship is applied for. If you do not receive this email, please contact tickets@munciecivic.org immediately.