LIMTF - MS Registration — Long Island Musical Theatre Festival

MIDDLE SCHOOL INTENSIVE - SUMMER 2019

Student Information

STUDENT NAME

First Name

Last Name

TOWN OF RESIDENCE

SCHOOL

MUSIC / THEATRE TEACHER

CURRENT GRADE

VOCAL RANGE

Please note that you may be asked to sing a voice part other than what you enter here.

AUDITION SONG TITLE / SHOW

AUDITION VIDEO

http://

PLEASE SELCT ONE

CONTACT INFORMATION

STUDENT E-MAIL

STUDENT CELL PHONE NUMBER

(###)

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PARENT/GUARDIAN INFORMATION

PARENT / GUARDIAN NAME

First Name

Last Name

PARENT / GUARDIAN EMAIL

PARENT / GUARDIAN CELL PHONE NUMBER

(###)

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EMERGENCY CONTACT INFORMATION

EMERGENCY CONTACT NAME

First Name

Last Name

EMERGENCY CONTACT PHONE NUMBER

(###)

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ANYTHING ELSE YOU'D LIKE US TO KNOW?