MTI 2024 Performance Intern Registration

Performer's Name(Required)

First Last

Performer's Grade 2024–2025 School Year(Required)

Performer's Date of Birth(Required)

Parent/Guardian's Name(Required)

First Last

Parent/Guardian's Email(Required)

Parent/Guardian's Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Emergency Contact 1 Name(Required)

First Last

Emergency Contact 1 Phone(Required)

Emergency Contact 2 Name(Required)

First Last

Emergency Contact 2 Phone(Required)

T-Shirt Size(Required)

Session Choice(Required)

I am auditioning for Session 1 (Legally Blonde) only.

I am auditioning for Session 2 (Seussical) only.

I am auditioning for both Sessions/shows.

Lunch Preference Session 1(Required)

I want to buy a Pingry lunch for all 3 weeks of Session 1

I want to bring my lunch from home for all 3 weeks of Session 1

Lunch Preference Session 2(Required)

I want to buy a Pingry lunch for all 3 weeks of Session 2

I want to bring my lunch from home for all 3 weeks of Session 2.

Lunch Purchase

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total

You authorize your card to be charged for this amount:

Allergy/Medical Disclosure

Does your child have an allergy that requires the use of an Epi Pen or a device designed for self-administered asthma treatment (not necessarily Epinephrine)?(Required)

Yes

My child is allergic to:(Required)

Check all that apply from the choices below(Required)

An Epinephrine injector has been prescribed for my child.

A device designed for self-administered emergency treatment (not necessarily Epinephrine) has been prescribed for my child.

My child has one of the above-referenced devices and has received adequate training on how and when to use their device, and can use it properly in case of an emergency.

My child has one of the above-referenced devices but has not received adequate training on how and when to use their device, and can not use it properly in case of an emergency.

No device(s) similar to those mentioned above has been prescribed for my child.

Any medical, emotional, or special needs you would like us to be aware of:

Agreements

May we use photographic images and sound bytes of your child for promotional material?(Required)

Yes

How did you hear about us?

Previous attendee

Friend of family member

Internet search

Social media

elefantemusic.com

Other

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Date

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If you click “Submit” and receive an error message, do not click again. Email karen@elefantemusic.com and we will check the status of your appointment registration.

Fill out separate audition form

Please note: After you click Submit, below, you will automatically be sent to the Musical Theater Intensive 2024 Audition Form. Please fill out the form immediately to reserve your mandatory audition slot.