Student Information Form

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Student Information Form

2019 Hopewell Memorial Jr. High Musical
Production of "Mary Poppins, Jr."

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* Indicates required question

Student Name *

Your answer

Age *

Your answer

Grade Level *

6

7

8

Homeroom Teacher *

Last name only. (Please do not use Room Numbers.)

Your answer

Cast or Crew *

Please indicate whether the student would like to be a member of the Cast or Stage Crew.

Cast Member

Stage Crew

PARENT CONTACT INFORMATION

Parent/Guardian Names *

Your answer

Street Address *

Your answer

City/State/Zip *

Your answer

Primary Phone *

Your answer

Secondary Phone

(optional)

Your answer

Primary E-mail *

Your answer

Secondary E-mail

(optional)

Your answer

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