Theme Festival

Teacher Information

Teacher: First Name *

Teacher: Last Name *

Teacher MTAC-OCC Branch # *

Teacher: Phone # *

Teacher: Email *

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Student Information

First Name *

Last Name *

Phone *

Email *

Date of birth *

Student Level *

Student Instrument / Vocal Range *

Non-Competitive (Adjudicator Comments Only)

Yes

Does Student have siblings applying for this Recital? *

Please list name(s) of sibling(s) also applying for this Recital

Parent/Legal Guardian Information (If Student is < 18)

Gaurdian: First Name

Gaurdian: Last Name

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Participation Consent Waivers

Media Waiver

Consent & Release Agreement

Children's Online Privacy Protection Act (COPPA) Parental Permission Form

Media Waiver *

By Checking this box, you acknowledge that you have read and agree to the "Media Waiver" Terms and Conditions. By checking this box you also acknowledge you are 1) 18 or older or 2) the parent or legal guardian of the applicant under age 18.

Consent & Release *

Children's Online Privacy Protection Act (COPPA) Parental Permission Form *

By checking this box, you acknowledge that you have read and agree to this Term and Condition. By checking this box you also acknowledge you are the parent or legal guardian of the child applicant (“Minor”). or an 18 or older.

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Repertoire

Composer: Name *

Title of Work *

Exact Timing *

Preferred Performance Time AM | PM

Accompanist Name (if applicable)

Partners

Comments

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