Working through Trauma with Theater

Participation Form

Interested in joining us for a year of healing and theater? Please fill out the form below if you are between the ages of 12-18, can commit to all three shows, and are interested in theater (cast or crew).

Disclaimer

All information given to Acts of Healing, about your actor, will be strictly confidential.

Actor Name

First Name

Last Name

Actor's Preferred Pronouns

Actor's Age

Actor's School

Parent Name

First Name

Last Name

Phone

(###)

###

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Email

Parent Name

First Name

Last Name

Phone

(###)

###

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Email

Relationship

Therapist Name

If Applicable

Is there anything else we should know before working with your child?