Your Phone Number

Age?

What talent will you be performing?

Title of your performance (if applicable):

Will you need music or audio/visual support? (Yes / No – If yes, please describe.)

How long is your performance? (Please keep it under 5 minutes.)

Will others be performing with you? (Yes / No – If yes, please list their names.)

.Parental Consent (if under 18) Parent/Guardian Name: Parent/Guardian Phone:

Do you give permission for your child to be photographed or videoed during the event?