R2P Production/Technical Crew Intake Form

Who is filling out this form? *

Student

Parent/Guardian

Primary Contact Info

This section is so we know how to contact you and your important adults. Emails about auditions, casting, and rehearsals will go to the addresses given for the company member and parent/guardians.

First Name *

Student's legal name (There is a place to put your chosen/preferred/nickname below)

Last Name *

Chosen/Preferred/Nickname (if different from above)

This is the name you want us to use during auditions, rehearsals, etc.

Primary Email *

Primary phone *

Mailing Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Email

Parent/Guardian 1 Primary Phone *

Parent/Guardian 1 Alternate Phone

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Primary Phone

Parent/Guardian 2 Alternate Phone

Emergency Contacts

These contacts should be adults who are NOT listed above. This is in case we cannot reach your parents/guardians in case of emergency.

Emergency Contact Person 1 Name *

Someone other than a parent/guardian listed above – this is to give us another adult to contact if we cannot reach your parents/guardians.

Emergency Contact Person 1 Relationship *

Emergency Contact Person 1 Primary Phone *

Emergency Contact Person 1 Alternate Phone *

Emergency Contact Person 2 Name *

Someone other than a parent/guardian listed above – this is to give us another adult to contact if we cannot reach your parents/guardians.

Emergency Contact Person 2 Relationship *

Emergency Contact Person 2 Primary Phone *

Emergency Contact Person 2 Alternate Phone *

ABOUT YOU

This section will help us better understand who you are as we watch your audition and during the casting process.

Getting to know you...

Tell us three things that give us a peek at who you are in a nutshell. (For example: 1. I'm super into D&D. 2. I live for my three kitties. 3. Never get between me and a pile of french fries.)

Birthday *

What are your pronouns? *

May we use these pronouns when talking with your family? *

Yes

No

If no to the previous question, what name and/or pronouns would you like us to use when talking with your family?

I identify as... (select any that apply)

These are the categories as defined by the US Census. If you would like to provide additional information, you can use the Comments box near the end of this form.

Current Grade *

(Or grade you are going into this coming school year if on summer break)

Current School *

(Or school you are going into this coming school year if on summer break)

Current School (if not listed in previous question)

Please describe any previous technical theatre experience, if any. Please indicate show, role, theatre group, and year, if known.

I would like to be considered for playing in an orchestra pit:

Yes, please contact me about this.

Please describe any other skills you’d like to share with us. These could include gymnastics, circus, stage combat, puppetry, roller skating, etc.:

Please describe any other information that would be important for us to know.

This might include medical, health, safety, etc. This response is optional and only for our information. R2P can make no specific guarantees to take any specific actions with regard to this information.

Participation in R2P is 100% FREE! There was a time when participation in R2P cost $500 per show. If that were still the case,

How did you hear about R2P?

Additional Comments?

CROWDSOURCING SUPPORT FOR R2P

To help us cover our costs, we rely on local businesses for sponsorships, program ads, and other resources. The R2P community is the best way for us to make new connections. If you can help us connect with a business, please complete the questions below.

I have a business contact to share. This business is:

My family's business

Someone I know

I believe this business may be interested in helping in the following way(s):

Donating services (legal, accounting, fundraising, etc.)

Donating goods (materials, food/beverages, etc.)

Advertising in the programs

Sponsoring a show

Name of business

Name of contact

Contact info (phone number and/or email address)

Notes

Please add any notes that you think would be helpful for Joey to know, e.g. "The owner is my neighbor and has seen shows before" or "I've spoken with them and they are expecting your call," etc.)

My parent/guardian is also interested in helping

Please describe areas of interest, skills, and/or professions that could be beneficial to R2P (fundraising, legal, financial, etc.)

Techncial/Production

Tech

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Required Signatures

Please read the following sections carefully. Both student/company member and a parent/guardian must read and agree to the following:

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R2P CONDUCT PLEDGE

As a Running to Places company member, I agree to conduct myself as a responsible citizen at all Running to Places activities including rehearsals, work calls, performances or special events.

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This includes but is not limited to refraining from using non-prescribed drugs or alcohol prior to or during R2P activities, adhering to all local, state and federal laws, refraining from any discrimination of others based upon

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race, religion, culture, sexual orientation or identity, or other personal qualities, and refraining from any behavior which threatens or risks injury to others including sexual harassment. In summary, I endeavor to conduct myself as a responsible,

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respectful member of Running to Places Theatre Company, as well as our larger community, and to expect the same behavior from those around me. I understand that my participation in Running to Places is dependent on adhering to this conduct pledge, so that

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we can operate as a company in a safe, positive environment.

PLEASE CHECK: *

We agree

Indicate that you agree to the R2P CONDUCT PLEDGE by checking here.

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STUDENT IMAGE & NAME MEDIA RELEASE WAIVER

I give permission for my child’s image or photographic representation (in any medium) and name to be used for publicity for Running to Places Theatre Company. This permission applies to, but is not necessarily limited to, images on the official website,

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posters to publicize performances, and media features or articles which include photographs and/or video of students and the production. I understand that these representations may be anonymous or the student(s) portrayed may be identified.

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I also give permission to release such representations to news agencies in any form and including the release of my child’s name as a member of this company.

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This waiver also applies to any mode of photography or representation used at any event associated with my/my child’s participation with Running to Places going forward.

PLEASE CHECK: *

We agree

Indicate that you agree to the STUDENT IMAGE & NAME MEDIA RELEASE WAIVER by checking here.

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MEDICAL INFORMATION RELEASE, PERMISSION TO TREAT, & ACKNOWLEDGEMENT OF RISK

I give permission for my child's medical information as provided when signing up for auditions and submitted during this season, to be shared with production personnel as relates to their well-being and safety.

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This may include but is not limited to stage managers, costumes designers and their assistants, run crew personnel, directors and their assistants, and any medical personnel who may need to attend to them during their activities with R2P.

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I also grant permission to administer basic first aid and seek medical treatment as the situation warrants. I also acknowledge that while being involved in theatre is relatively safe and that R2P promotes high safety standards,

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there is a certain amount of risk involved and injuries may occur. I also acknowledge being notified that Running to Places Theatre Company does not provide health care coverage for its participants,

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and any medical treatment sought should be billed to the participant’s responsible parties and not Running to Places Theatre Company.

PLEASE CHECK: *

We agree

Indicate that you agree to the MEDICAL INFORMATION RELEASE, PERMISSION TO TREAT & ACKNOWLEDGEMENT OF RISK by checking here.

Student Electronic Signature *

Company member should type their full name here

Parent/Guardian Electronic Signature *

Parent/Guardian should type their full name here

...

What's next...

Once you've submitted your form, you will receive an email at your primary address that contains a link to create an R2P User Account. Once you've logged in, please go to the dropdown menu and select "Update My Profile" to submit a photo of yourself.

. . .

Once logged in, you also can make changes to any of the information you submitted. If you have questions about any of it, you can email info@runningtoplaces.org or call/text 607-216-8750.

Data Privacy & Consent

Yes, I agree to receive text messages from Running to Places Theatre Company.