Bard Youth Fest Application | Bard on the Beach

Participant Information

First name *

Last name *

Preferred Pronouns (optional)

Date of birth *

Preferred email address(es) for all communications

Participant Cell *

This will only be used if we need to contact participants urgently (ex. they’re arriving independently and are over 15min late). If the participant doesn’t have a cell or are uncomfortable providing the number, please write N/A.

Emergency Contact Information

First emergency contact name *

Relationship to participant *

Cell phone *

Second emergency contact name *

Relationship to participant *

Cell phone *

Participant Health & Safety

This information will be kept confidential and will only be referenced in the unlikely event of an emergency.

Please list any health concerns the participant may have (eg. asthma, diabetes, epilepsy etc) *

Please list any allergies the participant has, the severity of the reaction and any special instructions *

Does the participant carry an epi-pen? *

Yes

No

If yes, do they know how to administer it?

Yes

No

Please list any medications the participant is currently taking, and please specify if they will be bringing this medication to rehearsal.

Please note any access needs you’d like us to be aware of (physical, mental, social, or emotional).

Or, if you’d prefer, please email [email protected] and let us know how we can best support the participant.

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Participant Information

Emergency Contact Information

Participant Health & Safety