Mosaic Youth Theatre of Detroit Online Registration

Registration

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Welcome to Mosaic's 2024 Summer Camp Registration Page!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier*

# of people in your household?*

Annual Household Income*

Do you receive food benefits?*

Do you receive cash benefits?*

Consider for scholarship? Y/N*

Contact #1

Parent/Guardian 1 First Name*

Last Name *

Relationship to Student*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name

Last Name

Relationship to Student

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

School*

Grade Level in Fall*

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Student Race*

Please click on the "Select Class" button below, then select the summer camp that best fits the needs of your family and young artist.

Please note that scholarships will only apply to a single two week camp session.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

School*

Grade Level in Fall*

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Student Race*

Please click on the "Select Class" button below, then select the summer camp that best fits the needs of your family and young artist.

Please note that scholarships will only apply to a single two week camp session.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

School*

Grade Level in Fall*

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Student Race*

Please click on the "Select Class" button below, then select the summer camp that best fits the needs of your family and young artist.

Please note that scholarships will only apply to a single two week camp session.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

School*

Grade Level in Fall*

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Student Race*

Please click on the "Select Class" button below, then select the summer camp that best fits the needs of your family and young artist.

Please note that scholarships will only apply to a single two week camp session.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email*

T-Shirt Size*

School*

Grade Level in Fall*

Disabilities*

Special Needs*

Allergies*

Medications (Leave blank if NONE)

Student Race*

Please click on the "Select Class" button below, then select the summer camp that best fits the needs of your family and young artist.

Please note that scholarships will only apply to a single two week camp session.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Required Policies

(Show-Hide Details)