2023/24 High School Apprentice Application Items required for completionThe following items are required in order to complete this form online. This form must be completed in one visit, as your progress will not be saved. A parent or guardian will need to be present to complete this form with you. Select All Information on your interests, background, and experience Medical Release and Emergency Contacts Consent and Release Permission to Photograph/Record Student Name* First Last Your Pronouns Email* Phone Number*Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Date of Birth* MM slash DD slash YYYY School Name* Grade level in 2023/24 school year* 11 12 Voice Part (if a singer)SopranoAltoTenorBass/BaritoneParent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone* QuestionsDescribe your prior experience, if any, with music and/or theater, both on and offstage.*What do you hope to gain from participating in the High School Apprentice Program?*What are your future education and/or career plans?*What aspects of music / theater interest you the most – for example being a performer, being a composer, working backstage, running a company?* Medical Release FormEmergency Contact #1 Name* First Last Relationship* Emergency Contact #1 Cell Phone Number*Emergency Contact #1 Email* Emergency Contact #2 Name First Last Relationship Emergency Contact #2 Cell Phone NumberEmergency Contact #2 Email Physician's Name First Last Physician's Phone NumberMedical conditions we should know about (including drug/food allergies):Medications being takenOther InformationI hereby give permission for Madison Opera staff to administer medical treatment and/or transport the previously-named Apprentice to a local hospital in the event of any accident, injury, or sickness.Parent/Guardian Name* First Last Consent and ReleaseWe, the undersigned, consent to participate in the Madison Opera High School Apprentice Program. We release and discharge Madison Opera and all of its employees, agents, volunteers, and any other persons or organizations (the “Releasees”) associated with the High School Apprentice Program from any and all claims, rights of action and causes of action for damages of any nature we may have, both compensatory and punitive, which arise out of Apprentice’s participation in the High School Apprentice Program. This includes damages or losses that are caused by, and arise out of, the negligence of the Releasees. We have read this Consent and Release. It is intended to be a prospective waiver of all claims of any nature we may have against those released. By signing this Consent and Release, we have full knowledge that the Releasees will not be liable to us, nor will we be compensated, for personal injuries or any other damages sustained while participating in the Program. Parent/Guardian Name* First Last Student Name* First Last Permission to Photograph/RecordMedia release*On occasion, Madison Opera will use video, photographs, and other media of the High School Apprentices to support the organization's mission. My child may be photographed/recorded for this purpose My child may not be photographed/recorded for this purpose Parent/Guardian Name* First Last PhoneThis field is for validation purposes and should be left unchanged.
