Plymouth’s Got Talent Registration Form General Information Name:________________________________ Grade in Fall: ____________________ Others performers in act (if any): Age:____________________________ _____________________________________ Phone: __________________________ _____________________________________ Cell Phone:_______________________ _____________________________________ Email:___________________________ _____________________________________ Parent Name (if under 18): _____________________________________ _________________________________ Act Details Act Name: Type of Act: _______________________________ Singing Dance Routine What will your be bringing for your act (keyboard, music, etc.): _______________________________ Piano Acting Skit Gymnastics Magic Martial Arts Cheerleading Comedy Other _______________ _______________ _______________________________ _______________________________ _______________________________ Musical Performance Authorization (parents signature required if under 18) I have read and agree to ALL of the Plymouth’s Got Talent rules and I give permission for my child ______________ to participate in the talent show. Contestants will acknowledge there are risks associated with this events, which include, but are not limited to personal injury, risk of loss or damage to personal property. Contestants voluntarily enter the Plymouth’s Got Talent show and in doing so assumes all of these risks. Contestants upon entry of this contest and upon signing this form hereby agrees to waive and release the Plymouth Chamber of Commerce from any liabilities of any kind arising from this event. Contestant hereby swears that to the best of their knowledge they are physically and mentally fit to perform in this event. Print Name: _________________________________ Sign Name:__________________________________ Date: __________________ If you win, you can advance to the Junior Amateur Talent Competition held at the Wisconsin State Fair on August 14th. (Only applies to those 18 years old and younger). Are you interested in advancing to the next level? ________________________