Form no. 05051CT CH-AH 6/2018
Child Theatre Application
Name:
First Middle Last Suffix
Affiliation: (please select one that best applies to the student)
☐ Chickasaw ☐ Chickasaw family ☐ Other tribe ☐ Non-native ☐ CN employee (non-native)
Mailing address:
Street/P.O. Box City State ZIP
□ Same as mailing address
Physical address:
Street City State ZIP
Birth date: Email:
Please list an email that you check regularly
Phone: ( ) Preferred communication method: □ Call □ Text ☐ Email
Parent/legal guardian information: (please complete this section if the applicant is a minor)
Parent/legal guardian name:
First Middle Last Suffix
Birth date (for security purposes): Phone: ( )
Parent/legal guardian name:
First Middle Last Suffix
Birth date (for security purposes): Phone: ( )
Emergency contact: (Please list two individuals (other than parents/legal guardians) to call in case of an emergency.)
Name: Phone:
Name: Phone:
Class selection: (Please select the class(es) that you or your student are interested in attending.)
□ After school theatre club (ages 8-12)
Designed to teach foundational skills-building, terminology and good stage habits.
□ Special effects makeup (ages 8-12)
In this one-class workshop, students will learn basic special effects makeup such as injury, age and animal.
□ Stagecraft and design (ages 14-18)
Students will learn basic design and construction of theatrical sets and props.
□ Musical theatre (ages vary by class)
In this class series, students will participate in a junior-version of musicals in a class setting. Voice, movement and
acting will be the focus, resulting in a musical production.
Department of Culture and Humanities/Arts and Humanities Division
Performing Arts
