THE CLEMSON LITTLE THEATRE

Emergency Contact Form

NAME OF SHOW *

LAST NAME *

FIRST NAME *

ROLE IN PRODUCTION *

EMAIL ADDRESS *

EMERGENCY CONTACT 1

NAME *

CELL PHONE *

RELATIONSHIP *

EMERGENCY CONTACT 2

NAME *

CELL PHONE *

RELATIONSHIP *

IF CAST / CREW MEMBER IS UNDER 18

Only complete this section if the participant is under 18 years old

PARENTS/GUARDIAN NAME

CELL PHONE

MEDICAL INFORMATION

KNOWN ALLERGIES

MEDICAL CONDITIONS