Appt.

Time:

Scout:

NAME
AGE:

PHONE H:

EMAIL:

PHONE C:

CITY:

PROVINCE:

PARENTS
NAME

MOTHER:

FATHER:

PARENTS
OCCUPATION

MOTHER:

FATHER:

DANCING

ACTING

POSTCODE:

MODELING

SINGING

Circle which of the following

HOW DO YOU CURRENTLY VIEW YOURSELF (OR YOUR CHILD)?

* SHY * SHY BUT WARMS UP * A REAL HAM! * CONFIDENT * OUTGOING
* CHARMING * WITTY* ABILITY TO MEET PEOPLE * EXPRESSIVE * SPONTANEOUS
* POISED* FOLLOWS DIRECTION * MAKES EYE CONTACT* CREATIVE
DESIRED RESULTS: WHICH ARE MOST IMPORTANT TO YOU AND OR YOUR CHILD?
* CONFIDENCE* POISE * REPRESENTATION BY AGENT
* PRINT WORK* ACTING * COMMERCIALS
* MONEY FOR COLLEGE * DISCIPLINE * TO ENTERTAIN
* LEARN SOMETHING NEW * TRAVEL * BECOME FAMOUS * FUN
OTHER:

PERSONAL INFORMATION:
GRADE POINT AVERAGE:

(3.0 MIN. REQUIRED)

SPORTS AND HOBBIES:

HAIR:

EYES:

HEIGHT:

SHOE SIZE:

OTHER TALENTS OR AWARDS:

DO YOU HAVE ANY PREVIOUS TRAINING OR EXPERIENCE?

ON A SCALE OF 1 TO 10 (10 BEING MOST IMPORTANT) HOW IMPORTANT IS THIS?

ARE BOTH PARENTS SUPPORTIVE OF THIS ENDEAVOR:
CALLBACK
SCOUTS NOTES

MOM

DAD
MAYBE

YES