UNI Spectrum Project Performer Registration

Thank you for your interest in the Spectrum Project. Please complete this registration form to sign your child up for the 2021 Spectrum Project Connections.

After completing registration, you will be emailed a link to a Performer Information Form. This form will ask you to supply additional information about your child that will help us provide an enjoyable and safe experience for them at Spectrum Project.

2021 registration: $10. Payable online.

Dates of all Connections

Feb. 6, 2021

Feb. 20, 2021

March 6, 2021

March 20, 2021

April 3, 2021

April 17, 2021

Questions? Contact Kevin Droe at kevin.droe@uni.edu or 319-273-3073

Performer Information

Performer First Name *

Performer Last Name *

Performer Age *

Performer School *

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian E-mail Address *

Parent/Guardian Phone Number *

Where parent/guardian can be reached during Saturday rehearsals (1-2:30 p.m.)

Parent/Guardian Street Address *

Parent/Guardian City *

Parent/Guardian State *

Parent/Guardian Zip *

Parent/Guardian Information #2 (Optional)

Parent/Guardian First Name (2)

Parent/Guardian Last Name (2)

Parent/Guardian E-mail Address (2)

Parent/Guardian Phone Number (2)

Where parent/guardian can be reached during Saturday rehearsals (1-2:30 p.m.).

Parent/Guardian Street Address (2)

Parent/Guardian City (2)

Parent/Guardian State (2)

Parent/Guardian Zip (2)

Parent/Guardian Information #3 (Optional)

Parent/Guardian First Name (3)

Parent/Guardian Last Name (3)

Parent/Guardian E-mail Address (3)

Parent/Guardian Phone Number (3)

Where parent/guardian can be reached during Saturday rehearsals (1-2:30 p.m.).

Parent/Guardian Street Address (3)

Parent/Guardian City (3)

Parent/Guardian State (3)

Parent/Guardian Zip (3)

Emergency Contact

Someone who could be contacted on Saturdays during Spectrum Project time if parents or guardians can't be reached.

Emergency Contact Name *

Emergency Contact Phone Number *

Relationship to performer *

Video and Media Release

Performers may be video recorded, photographed or audio recorded periodically for educational and promotional purposes. If this media is shared with another party, student names will not be used. Any use of your child's image on SpectrumProject.org will not include last name.

Please select... *

Yes, I or my child can be video recorded, photographed or audio recorded periodically for educational and promotional purposes.

No, please do not share any video recordings or photos.

Name that will appear on the credit card you'll use for payment (if applicable):

Leave this field blank