Child's Information:

First Name

*
only characters, like abcd

Last Name

*
only characters, like abcd

Gender: *

Birthdate:

*
only date (mm/dd/yyyy), like 01/31/2008

Hair Color:

Eye Color:

Height (Ft.): (In.):

Weight (lbs):

Most Interested In (Please Check All That Apply):

Acting:	Singing:	Dancing:	Writing:	Hosting:
Music:	Filmmaking:	Modeling:	Voice-Over:	Comedy / Improv:

Any 1's, 2's, D's, F's on reportcard?:

Does child have or is able to have SSN?:

Represented by talent/modeling agency?:

If so , who ?:

Interviewed with talent agent/manager ?:

If so , who ?:

Auditioned for commercial or print job?:

When? Where?:

Booked a commercial, T.V. or print job ?:

Which one?:

Parent/Guardian's Information:

Mother's First Name: *At Least One Parent Required		Mother's Last Name:
Father's First Name:		Father's Last Name:
Guardian's First Name:		Guardian's Last Name:
		Guardian's Relationship:
Primary Email * email address, like user@domain.com		Secondary Email:
Street Address
City	State
Zip * only numbers, like 1234
Mother's Occupation:		Father's Occupation:
Total Kids in Household:		Household Income:
Primary Phone * phone number in 999-999-9999 format		Primary Phone Type:
Secondary Phone		Secondary Phone Type:
Best Time to Call: *
*Required - Be Sure All Fields With a Star Are Filled Out Correctly Before Submitting