Participant Information Form

Participant Information

Show

First name

M.I.

Last name

Preferred Pronouns

Phone

Full Address

Age

Birthday

Month

Day

Year

Would you like to purchase a cast t-shirt for $25?

Yes

Emergency Contact Information

Emergency Contact #1:

Full Name

Phone

Relationship

Emergency Contact #2:

Full Name

Phone

Relationship

If participant is a under 18, please list the full name(s) of those permitted to pick up. Minors will only be allowed to leave with individuals listed on this form. Also, please state if the participant can sign themself out to either drive themself home or meet in the car park. If this isn’t stated, parents/guardians will be required to come into the building to sign out the participant.

Pick up permission

Please check if participant will be driving themself to and from rehearsals/ performances.

Participant Medical Information

Please list any allergies and/or medical conditions we should be aware of in case of an emergency.

Please list any make-up allergies (latex, face paint, powder, glue, etc.)

Physician Name

Phone

Insurance Provider

Member ID

Group ID (if applicable)

Please check and sign if Valkyrie Theatre Company has permission to call an ambulance and seek medical care in the case of an emergency.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Is there any other information we should know?

All information given is to the best of my knowledge. If the participant is under 18 years old, this form must be signed by a parent or guardian.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Full Name

Date

Participant Information Form

Participant Information

First name

M.I.

Last name

Preferred Pronouns

Phone

Age

Birthday

Month

Day

Year

Would you like to purchase a cast t-shirt for $25?

Yes

Emergency Contact Information

Emergency Contact #1:

Emergency Contact #2:

Please check if participant will be driving themself to and from rehearsals/ performances.

Participant Medical Information

Please list any allergies and/or medical conditions we should be aware of in case of an emergency.

Please list any make-up allergies (latex, face paint, powder, glue, etc.)

Group ID (if applicable)

Please check and sign if Valkyrie Theatre Company has permission to call an ambulance and seek medical care in the case of an emergency.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Is there any other information we should know?

All information given is to the best of my knowledge. If the participant is under 18 years old, this form must be signed by a parent or guardian.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.