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Page 1

Mosaic Logo





Participant Information



Participant Phone Number and Email






Participant Address Information




Participant Education and Scholarship Information



Caregiver(s)

Primary Caregiver









Secondary Caregiver









Emergency Contact Information and Other Information









If not applicable, put NA

If not applicable, put NA

If not applicable, put NA

Required Policies

Ensembles Parent/Family Agreement

By enrolling your young artist in Mosaic's programs, You agree to the following Parent/Family Agreements:

Be Accountable:

  • Take responsibility for your words and actions.

  • Submit all paperwork on time.

Be Present

  • Attend parent meetings and workshops, performances, and culminating events.

  • Contribute to a community of support for Mosaic as able; including volunteerism and/or fundraising.

Be Prepared

  • Review Mosaic policies and commitments with young artist(s) and your village of support.

  • Assure that young artists have reliable and timely transportation to and from Mosaic activities.

Be Supportive

  • Support young artists in fulfilling their commitments.

  • Share information about Mosaic's performances and programs with your networks.

Be Committed

  • To your young artists' college exploration and decision-making process, including and up to participation in any college and financial aid workshops and completion of the young artist's FAFSA

  • To your young person's artistic, scholastic, and personal journey

Ensembles Young Artist Agreements

Be Accountable

  • Take responsibility for your words and actions

  • Complete tasks on time Strive for excellence on stage and in life.

Be Present

  • Attend all assigned rehearsals, leadership & life skills sessions and performances.

  • Be fully engaged in the artistic process

  • Arrive on time.

  • Leave on time.

Be Prepared

  • Bring all necessary materials to rehearsals, productions and events

  • Know lines/music, blocking, cues, and choreography

Be Supportive

  • Accept others for who they are

  • Encourage others to explore their uniqueness

Be Committed

  • Give your best to yourself and your personal growth on stage and in life.

  • Give your personal best to the process.

  • Contribute your best to the rehearsal and performance environment. Only the best, nothing less!



Medical Emergencies

I understand that health/accident insurance coverage is the responsibility of the parent/guardian. I hereby give permission to Mosaic Youth Theatre of Detroit staff and representatives to secure medical, routine medical, surgical treatment, and non-surgical care for the Young Artist names on this form. I authorize Mosaic Youth Theatre of Detroit staff and representatives to transport the Young Artist to the nearest hospital in case of injury, suspected injury, emergency, or suspected emergency in a private vehicle, rented vehicle, or ambulance, whichever is deemed necessary while the participant is in attendance of rehearsals or performances with Mosaic, if the parent/guardian cannot be reached. I absolve Mosaic Youth Theatre of Detroit and all of its representatives of any and all liability, financial and/or otherwise arising from the administration of any medical care to my Young Artist under the terms of this release. Mosaic Youth Theatre of Detroit is not responsible for payment of any medical expenses incurred during participation in Mosaic Youth Theatre of Detroit’s training programs.


Media Release

I give my permission for the photographing, audio recording, videotaping, and/or the publication of an existing photograph, audio recording or video of the above named child by Mosaic Youth Theatre of Detroit in its educational, promotional or fundraising materials. I understand that there will be no remuneration or other consideration for the above name child’s participation. I understand that the reproduction of the aforementioned, either in whole or in part, or alone or in conjunction with other photographs, sketches, art work, videotapes, audio recording and text matter, is to be used by Mosaic Youth Theatre of Detroit, its employees, agents, licensees and assignees now and at any time in the future for educational, informational, fundraising, and publicity purposes, and for radio and television broadcasting and distribution, advertising, trade promotion, or art purposes in publications and other advertising and promotional media, anywhere in the world, and I hereby consent to such use on behalf of the above named child. I hereby release Mosaic Youth Theatre of Detroit and its employees, agents, licensees and assignees from any and all claims arising out of such photographing, videotaping, recording, reproducing, broadcasting, publishing, or exhibiting or other use as is authorized by Mosaic Youth Theatre of Detroit or its affiliates.


Demographic Data Sharing

 I understand that Mosaic Youth Theatre of Detroit may use my demographic information as shared at enrollment in the following ways:

  • As represented in summary statements and reports regarding Mosaic Youth Theatre of Detroit for solicitation of funds and documentation of program outcomes

  • As aggregate data and demographics with funders and other key stakeholders to provide young artists and families with high-quality programming.