Will you be entering 9^th-12^th grade in the fall of 2022? (required)YesNo

Date of Birth (required)

Street Address (required)

Street Address 2

County (required)

School (required)

School District (required)

Preferred Email (required) Please note, some school districts restrict student email addresses from receiving out-of-district email. Provide a personal email if this is the case in your district.

Would you like to receive text messages?YesNo

Polo Shirt Size—Please choose an option—SMLXL2XL3XL

Are you applying to be a Teen Usher or Teen Ambassador? To apply to be a Teen Ambassador, you must have been in the Teen Usher program for at least one season. Teen Ambassadors are considered mentors of the Teen Usher program and will be viewed as a leader among their peers. Teen Ambassadors will have additional volunteer opportunities to be determined later.Teen UsherTeen Ambassador

All Teen Ushers and Teen Ambassadors are required to volunteer at each show on the 2022-2023 Premier Health Broadway in Dayton Series. Please go to the Dayton Live website if you have not looked at the calendar for the upcoming Broadway season. By checking this box, you acknowledge you have looked at the calendar and can commit to volunteering during these weeks throughout the year

This season, volunteer opportunities will be available throughout the run of performances at all Premier Health Broadway in Dayton shows – not just a select performance or two. You will be required to create an account with Better Impact, Dayton Live’s volunteer software, that all our volunteers use to manage their volunteering. This will allow you to sign up for specific shows and times on your own, manage your volunteer hours, and it will be our primary way of communicating with you. Please check this box acknowledging this.

Are you currently a Teen Usher or Ambassador?YesNo

If you are currently a Teen Usher or Ambassador, please list the number of years you have participated and describe your experience with the program. If you are not currently a Teen Usher or Ambassador, please skip to the next question.

Why do you want to be a part of the Teen Usher & Ambassador Program? (required)

Please describe why you would be the ideal Teen Usher or Ambassador. (required)

How did you hear about the Teen Usher & Ambassador Program? (required)

Email (required)

Email (required)

Medical Authorization/Release

By checking this box, I, the parent or legal guardian of the child/participant listed above, hereby certify that this child/participant does not have any medical condition which would preclude or restrict his/her participation in this program. I hereby authorize, consent and direct Dayton Live, its directors, officers, and employees, and any physician, hospital, or other health care provider selected by Dayton Live, to take such action as is necessary in the circumstances to provide emergency care and related treatment to my above-named child/participant in my absence, should the need arise while he/she is participating in this program.

Liability Waiver

By checking this box, I, the parent or legal guardian of the child/participant listed above, hereby give approval for the child/participant’s participation in this program. I do waive, release, absolve, indemnify and agree to hold harmless Dayton Live, its officers, employees, and volunteers from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Dayton Live.

Participation Fee

By checking this box, I, the parent or legal guardian of the child/participant listed above, acknowledge that there is a $30 participation fee if accepted into either the Teen Usher or Teen Ambassador program. Scholarships are available.

Photo/Video Release

By checking this box, I, the parent or legal guardian of the child/participant listed above, authorize Dayton Live to take pictures and/or videos of me (or my child) during this program and to use the photos or videos for both internal and external purposes, including marketing materials or social media postings. By submitting this release, I understand and agree that I will receive no form of compensation for pictures or videos of me or my child used by Dayton Live. I also agree to release Dayton Live of any and all liability arising from the taking and publishing of such photos or videos.