Student Name
Name of Guidance Councelor
Emergency Contact
Phone Number
Are you at least 16 years of age? Yes No
Do you have any experience with vaudeville? Yes No
How would you rate your physical fitness? Excellent Pretty Good Room for Improvement
What is your fear of heights? Comfortable Cautious Terrified
Which vaudeville acts are you interested in? Check all that apply
Acrobatics Fire Eating Human Cannonball Juggling
Flying Trapeze Lion Taming Knife Throwing Tightrope
Contortion Wall of Death Sword Swallowing Strongman
What is your primary creative outlet? Choose One Fine Art Writing Music Acting Dance Photography & Film What is your personality type? Choose One Lover Jester Everyman Caregiver Ruler Creator Innocent Sage Explorer Outlaw Magician Hero
In 300 words or less, explain the difference between courage and stupidity.Be specific and provide examples.
By signing here I acknowledge that participation in vaudevillian activities will likely result in physical injury, mental trauma, exposure of character flaws, arrest and/or incarceration or deportation, and even death. I hereby release the Stutsman County School District, and its affiliates, from any accountability for events that may otherwise be punishable in a court of law.
Student Signature Parent or Legal Guardian Signature Date
