Plymouth`s Got Talent Registration Form

Plymouth’s Got Talent
Registration Form
General Information
Name:________________________________
Grade in Fall: ____________________
Others performers in act (if any):
Age:____________________________
_____________________________________
Phone: __________________________
_____________________________________
Cell Phone:_______________________
_____________________________________
Email:___________________________
_____________________________________
Parent Name (if under 18):
_____________________________________
_________________________________
Act Details
Act Name:
Type of Act:
_______________________________
Singing
Dance Routine
What will your be bringing for your act
(keyboard, music, etc.):
_______________________________
Piano
Acting Skit
Gymnastics
Magic
Martial Arts
Cheerleading
Comedy
Other
_______________
_______________
_______________________________
_______________________________
_______________________________
Musical
Performance
Authorization (parents signature required if under 18)
I have read and agree to ALL of the Plymouth’s Got Talent rules and I give permission for my child ______________
to participate in the talent show. Contestants will acknowledge there are risks associated with this events, which include, but are not limited to personal injury, risk of loss or damage to personal property. Contestants voluntarily enter
the Plymouth’s Got Talent show and in doing so assumes all of these risks. Contestants upon entry of this contest and
upon signing this form hereby agrees to waive and release the Plymouth Chamber of Commerce from any liabilities of
any kind arising from this event. Contestant hereby swears that to the best of their knowledge they are physically and
mentally fit to perform in this event.
Print Name: _________________________________
Sign Name:__________________________________
Date: __________________
If you win, you can advance to the Junior Amateur Talent Competition held at the Wisconsin
State Fair on August 14th. (Only applies to those 18 years old and younger). Are you
interested in advancing to the next level? ________________________