Please be sure to print out the forms below and fill out completely and mail to:

K.Y.M.M.Inc. c/o Youth Talent EXPO / PO Box 742652 / Riverdale GA 30274

yteyteyteyteyteyteyteyteyteyteyteyteyteyteyeteyteyeteyteyeteyteyteyeteytyeteyetyeteyteyeteyeteyteyeteyteyeteyteyeteyetey

 

Youth Talent EXPO //// Registration Form:

 

 

Personal Information:

Birth Name _______________________ Nick Name ___________________

Parents Name ____________________________ Cell Number __________________

Address __________________________ City ________ State ____ Zip __________

Birthday ________________ Age _____

Height _____ Weight _____ Nationality ______

Distinguished Marks __________________________________________________

Childs Hobbies ______________________________________________________

Is parent or child active in community Y ___ N ___ If yes how: ________________________

______________________________________________________________________

Church & Education

Church Name ___________________ Pastor _______________ Bible Study Y ___ N ___

School Name __________________ City _________ Grade Average ____ Behavior Grade___

 

Medical Condition:

Good____ Fair____ Poor ____ If condition is fair or poor Please explain and please print clearly: ________________________________________________________________________

Emergency Contact Name ______________________ Number _______________ Relationship ___________

 

What catigory will you be performing in? Circle one

A ... Singing

B ... Singing & Dancing

C ... Dancing

D ... Great Memeory

E ... Comedian / Comedy

F ... Acting

G ... Group /Cheerleading

H ... Poetry / Spoken Word

 

Part "2"

Chaperone Information:

Name __________________________________

Address _______________________________________

Member of Family Y _____ N _____ Relationship __________________ to Childs Name__________________________

Phone number __________________________

Personal references 1. ___________________________ 2. ___________________________ 3. ______________________

Phone numbers to reference #1 _____________________ #2 ________________________ #3 ______________________

Place of work ___________________________ Address __________________________ Phone number _______________

Occupation/Position _____________________________________ Supervisor ___________________________________

Have you ever involved yourself in porn in any way? Y _____ N _____ If yes please explain: _________________________

________________________________________________________________________________________________

Have you ever been convicted of any type of crime? Excluding traffic. If yes please explain: _____________________________

_________________________________________________________________________________________________

I swear the information provided is true on all accounts. If any information is false you may be asked to depart the premises at once without explanation and no refund will be provided.

Signature __________________________________________ Date _____________________

Payment conformation # __________________ / sending copy __________.

Note:

Please fill out application completely, as it is important information for our records.

Failure to do so will result in the interruption of processing your information for the COMPETITION.

Please include the confirmation number or a copy of your receipt of payment,

when mailing in your application.

____

_________________________________________________________________________________________________

Do Not write in this area/ Administration Use Only:

________________________________________________________________________________________________________

childs name __________________________________

Registration received date __________ Amount received $______________

Payment form _____________________ check ___ money order ___ cash ___ visa ___