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Youth Talent Extravaganza Registration for Youth of All Ages Deadline to Register: 11.16.2023
Please be advised the form has to be completed by a Parent/Guardian if youth is a minor.
Event Date: November 18, 2023
Event Timing: 1pm -6pm
Event Address: First Baptist Church of Middlesex Gym
10242 Claude Lewis Road, Middlesex 27557
Contact Empowered Citizens at (919)-638-4451 or epc_org@outlook.com
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* Indicates required question
Email
*
Your email
Parent's Full Name
Your answer
Child's Full Name
Your answer
Email Address
*
Your answer
Child's Age
*
Your answer
Gender
*
Your answer
Phone Number
*
Your answer
What city do you live in?
*
Your answer
What talent will you be performing?
*
Singing
Dancing
Rapping
Poetry
Spoken Word
Modeling
Other:
Required
Liability Waiver:
I hereby request the above participant be accepted for participation in the above event. I agree to assume the responsibility for any accident or injury while the participant is engaged in the program activities and do hereby release and absolve the First Baptist Church of Middlesex and Empowered Citizens, their volunteers, supervisors or sponsors from any or all claims from such accident or injury. Pictures or video clips may be taken while participating in the event. I give my permission to the First Baptist Church of Middlesex and Empowered Citizens to use such photos and videos in promotional, news, or informational media.
*
I AGREE
Other:
Required
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