YOUNG AMERICANS REGISTRATON FORM:

Please return this form with check made payable to: The Mainstage Center for the Arts (MCA) by
September 1, 2008. Checks must include phone number. Your cancelled check will serve as your receipt.

REGISTRATION FEE: $80.00 per participant.

Childʼs Name: _____________________________________ Parentʼs Name____________________________

Address:_____________________________________________________________________________
_
City, State, Zip:_____________________________________________________________________________

Telephone Number: (________) _________________________________

Parent Cell # ( ) Parent E-Mail ________________________

Name of School: ______________________________ Grade in Fall ʻ08________

Name of Principal:______________________________________________________________

Telephone # of School ____________________ Fax # for School________________

T-SHIRT SIZE (Adult Sizes) XS SM MED LG XL XXL

____ I am willing to host 2 Young Americans.

____ I am NOT willing to host 2 Young Americans.

____ I am willing to volunteer some time during the three day workshop.

RETURNED CHECK CHARGE: ALL CHECKS RETURNED BY YOUR BANK WILL BE SUBJECT TO A $35.00
RETURN CHECK CHARGE. RETURNED CHECKS MUST BE REPLACED WITH A CERTIFIED CHECK,
CASHIERS CHECK OR MONEY ORDER AND MUST INCLUDE THE ADDITIONAL $35.00 CHARGE.

PAYMENT OPTIONS: _______ CHECK _________CASH ______ CREDIT CARD (if paying via credit
card please complete the authorization form below. Please be advised that there is a $2.00 service charge
for credit card use.)

Name of Cardholder:___________________________________ Card Number: ________________________

Type of Credit Card: Visa Master Card Exp. Date____________________

Authorizing Signature: ________________________________________ Date: ____________

Please note: pictures of these workshops and rehearsals will be taken for archival and publicity
purposes.
 EMERGENCY INFORMATION

Childʼs Name: ________________________________________________________

Parent or Guardianʼs Names:____________________________________________

Telephone Number: (home)______________________ (work)_________________

(cell)_________________________ parent email ___________________________

In case of emergency notify:_____________________________________________

Telephone Number;____________________________________________________

Name of Doctor:______________________ Telephone :_______________________

Hospital Preference:___________________________________________________

Insurance Carrier and number:___________________________________________

Allergies:_____________________________________________________________

Medications:__________________________________________________________

Pertinent medical history:_______________________________________________

_____________________________________________________________________

______________________________
Parent or Guardian Signature

HOW 36 PERFORMERS TRANSFORM 300 STUDENTS IN 3 DAYS!

Designed for those with lots of talent and training

AND for those who just love to sing!

Music brings people together for many purposes: teamwork,

respect, accomplishment, caring & self-discipline, a sense of
living in understanding in self-worth and MUCH more.

The Music Outreach Program aims to:
1. Encourage music in the

schools of our nation and the world.
2. Train young people in
performance.
3. Share insight and understanding of different
cultures.
4. Strengthen character and develop self-esteem, self-
worth and self-discipline.