Doylestown Theatre Academy - Winter Show Registration

Please complete form ONCE for each youth cast member you are registering.

First name

Last name

Birthday

Month

Day

Year

AGE on 10/1/2025

School Attending

Cast Member Address

Country/Region

Address

City

Zip / Postal code

Youth Cast Member Cell Phone (if applicable)

Youth Cast Member E-Mail (if applicable)

Parent Contact Information

Parent Contact #1 - First Name

Parent Contact #1 - Last Name

Parent Contact #1 - Cell Phone

Parent Contact #1 - E-Mail

Multi-line address

Country/Region

Address

City

Zip / Postal code

Parent Contact #2 - First Name

Parent Contact #2 - Last Name

Parent Contact #2 - Cell Phone

Parent Contact #2 - Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contacts

Persons lited must be reachable during rehearsal hours. Please list emergency contacts in the order of who to contact first.

Emergency Contact #1 - First & Last Name

Emergency Contact #1 - Cell Phone

Emergency Contact #1 - Relationship to Youth Performer.

Emergency Contact #2 - First & Last Name

Emergency Contact #2 - Cell Phone

Emergency Contact #2 - Relationship to Youth Performer

Medical Information & Special Considerations

FOOD ALLERGIES - List Food Allergies, below. PLEASE NOTE that DTA cannot guarantee an allergen-free environment. If Youth Performer has no food allergies - type n/a.

NON-FOOD ALLERGIES - Please specify any non-food allergies below. If youth performer has no non-food allergies, please type n/a.

Physical, Emotional or Behavioral Conditions

With awareness of your child's needs, staff may be able to modify activities and techniques for inclusiveness prior to the start of rehearsal.

Please specify any physical, emotional, or behavioral conditions. Please include triggers, signs and symptoms of these conditions, and techniques that you recommend in managing these behaviors.