Variety Curtain Up! Registration Form

Thank you for your interest in Curtain Up! 2019!

Jan Albus, Producer

Julie Probst, Associate Producer: jprobst@varietystl.org or 314-720-7718

Parent/Guardian Information

Cast Member Information

Your answer will not affect the status of your registration, and is not required. Variety uses this information when reporting statistics to grantors, our board of directors and other agencies.
*Each cast member will receive one complimentary t shirt.
Enter any additional diagnoses in the text area below

Additional Health Information

Select all that apply
Select all that apply
For instance - peanuts, bee stings, latex, etc. If none, please indicate that in the field below.
If your child has no limitations due to medical conditions, enter 'none'.

General Information

Emergency Contact Information

Enter contact information for the individual we should contact in the event of an emergency and we cannot reach you.