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12 Hour Theatre Program Expression Of Interest
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* Indicates required question
Name
*
Your answer
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Prefer not to say
Non-Binary
Other:
Email (Parent/Guardian's if under 18)
*
Your answer
Anything we should know about? This may include medical conditions, allergies, diagnosed behavioural/cognitive conditions or any injuries.
*
Please note: if Participant has an Anaphylaxis Action Plan or an Asthma Action Plan please email a copy to
programs@canberrayouththeatre.com.au
Your answer
Emergency Contact Name:
*
Your answer
Relationship to you:
*
Your answer
Phone Number
*
Your answer
I am available for Saturday 28 March, 9am to 9pm. I understand that I/my young artist needs to be available for the full 12 hours of this project
*
I agree
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