Matilda Audition Form
***Ages 12+ only.***

Director: Mary Hubbard
Music Director: Juan Carlos Alarcon
Choreographer: Lincoln Wright
Stage Manager: Leigh Taylor

Audition Dates/Location:
Sunday June 13th from 2 - 6pm and Monday June 14th from 6 - 9 pm
South Bend Civic Theatre: 403 N. Main Street, South Bend, IN 46617

Expected Rehearsal Schedule:
5 days a week, Mon - Fri, 6 - 9pm** starting July 5th; four days a week most weeks in July
**Some Saturdays or Sundays may be added as needed.
Tech Sunday: September 5th

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Your name: *
If under 18...how old are you?
What day would you like to audition? *
Is this your first time participating with South Bend Civic Theatre? *
If not cast, can we contact you with other ways to participate with this production? *
Email:
Address:
Primary Phone: *
Where do you work/go to school and what do you do?
Theatre Experience:
Vocal/Dance Experience
Please provide ALL conflicts (dates/times) from now until the end of performances. *
Ages 18+: Are you vaccinated?
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Ages 18+: If no, will you be fully vaccinated by August 9th?
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Ages 12-17: Have you had your first vaccination shot?
Clear selection
Ages 12-17: Will you be fully vaccinated by August 9th?
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If you are under 18, please fill out the following information:
Parent Name:
Parent Email:
Parent Primary Phone:
Parent Occupation:
All actors ages 12+ are required to be fully vaccinated by tech week in order to perform without a mask. Those who cannot be vaccinated due to extenuating circumstances can still perform, but will be required to wear a mask.  Actors under 12 will perform masked.  Please sign your name to indicate that you understand and consent to this policy. *
I give South Bend Civic Theater my permission to use photographic images, video, or audio recording of me gathered during my SBCT participation, for use now and in perpetuity, without compensation or further communication. By signing, I also consent that in the instance of a medical emergency and am unable speak for myself, I give SBCT staff permission to seek medical treatment on my behalf. I also agree to release SBCT from all liabilities in the case of injury to person and/or property.      Please type your full name below. *
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