2014 UpStage!

Registration Form

Date of Birth (M/D/Y) __________________ M F

Please briefly describe any conditions and or

accommodations we should be made aware of. This
information is strictly confidential.

Age (as of July 29, 2014) __________________________

______________________________________________

Address _______________________________________

______________________________________________

City, State, ZIP __________________________________

______________________________________________

Home Phone ___________________________________

______________________________________________

Cell Phone _____________________________________

Please list any allergies or intolerances: ______________

Email _________________________________________

______________________________________________

Primary Parent Contact (circle): Mother/Father/Guardian

If you are an adult, please list an emergency contact.

______________________________________________

Actor Name ____________________________________

Name _________________________________________

Please Read Carefully

Address (if different) ______________________________

Spotlight On Youth will provide reasonable supervision of

its participants within its care and control. However,
Spotlight On Youth is not an insurer of the safety of the
students, nor can it supervise all movements of all students
at all times.

Employer ______________________________________
Job Position/Title ________________________________
Primary Phone __________________________________
Work Phone ____________________________________
Email _________________________________________
Are any wheelchair/spatial accommodations necessary for
this actor?
Yes No

Spotlight On Youth, its staff, and its volunteers do not

assume liability for medical expenses, except in the case of
reckless behavior or an intentional act of injury to a
student.
Please Sign
I have read and understand the above statements.
Name ______________________________ Date _______

If yes, please explain: ____________________________

Preferred clinic/hospital system _____________________

I give consent to Spotlight On Youth to use media images

of my student for publicity and marketing purposes for the
organization.

Primary Doctor __________________________________

Name ______________________________ Date _______

______________________________________________

Insert Photo Here

UpStage! Role Placement Form

Full Name _________________________________________
Age __________ Height ___________ Weight ___________
Shirt Size (Adult or Child) __________ Pant Size __________
Eyes _________ Hair ___________ Gender: Male Female

Conflicts
UpStage! will rehearse Tuesday and Thursday evenings from 6:00-8:00, and Saturday mornings from
9:00-noon. Performances will be June 28 and 29 at CCRI. Due to the limited rehearsal time we have,
only a limited amount of absences will be permitted. It is our preference that each foreseeable
absence be listed prior to the start of our rehearsals. Please remember that our staff schedules our
daily rehearsals with the expectation that only those students excused will be absent.
Please list conflicts below:
________________________________________________________________________________
________________________________________________________________________________
Fees
There is a $125 fee for all students accepted into UpStage! This fee is due no later than Tuesday,
May 27th. Please make checks payable to Justin DePaolis-Metz, our artistic director, with Spotlight
On Youth in the memo section.
If this fee is a financial burden, please inform the Artistic Director, Justin DePaolis-Metz, at
fmspotlightonyouth@gmail.com as soon as possible. A partial payment, installments, or a fee waiver
may be negotiated. It is our goal that no participant is turned away because of financial issues.
Signatures
I have read the above information and completed it to the best of my knowledge.

______________________________________
Actor Name and Date

_____________________________________
Parent/Guardian Signature and Date

If more explanation is necessary regarding a condition or accommodation is necessary, please email

that information to Justin DePaolis-Metz at fmspotlightonyouth@gmail.com as soon as possible.
Again, this information is strictly confidential, and will only be shared with authorized personnel on a
need-to-know basis.