adventure

C I T Y AUDITION REGISTRATION FORM

Name_________________________________________

Date of Birth____________________________________

Auditioning for part of_____________________________

Address: Street___________________________
City________________________ State___________
Zip Code_______________

Do you have a cell phone? Yes___ No___

If yes, please list it here. ( ) -

Home Phone: ( ) -

Which do you check more frequently?

___ Email ___ Facebook

List either your email or your name on Facebook: ___________________________

Emergency Contact: ______________________ Relationship:________________

Phone Numbers: 1) _________________ 2) _________________

MEDICAL INFORMATION:

1) Are there any medical limitations?

2) Do you have any allergies?

3) Are you on any medications?

Health Care Provider: ________________________ Medical Number: ___________

IF UNDER 18, HAVE YOUR PARENT OR GUARDIAN SIGN THIS:

I give my child permission to work on the web series Adventure City and will try my best to help
out, drive, or support in whatever way I can. I will not hold Adventure City responsible if my child is
physically hurt. I promise not to sue Adventure City and I will talk to the producers if I think
something is wrong. I understand that my child could possibly perform stunts under careful
supervision.

X__________________________________