Butler Theatre Day 2026

First Name*

Preferred First Name

Last Name*

Birthdate*

Email Address*
Be sure to provide an email that you check regularly; all follow-up communication will be sent to this address.

Confirm your email*

What high school do you attend?*

In what grade will you be in September 2026?

What is your primary theatre interest (choose one)?

What is the first and last name of your Drama or English teacher/coach?

Drama or English teacher/coach email

How did you hear about this event? (Choose any that apply)*

OPTIONAL: If you would like to receive mail from Butler University/Butler Theatre, please provide your mailing address.

Country

Street

City

Region

Postal Code

Other:

Emergency Contact Information

Emergency Contact First Name*

Emergency Contact Last Name*

Emergency Contact Phone Number*

Relationship to you*

Are you currently age 18 or older?*

YES, I am currently 18 years old or older.

NO, I am younger than 18 years old.

Photo Release Waiver (required)

A parent or legal guardian must read and formally acknowledge (by signing) the photo/video release waiver outlined below. If you have extenuating circumstances, please contact the JCA recruitment office JCA@butler.edu or Wendy Schrepferman in the Butler Theatre department, wschrepferman@butler.edu.

Please read and formally acknowledge (by signing) the photo/video release waiver outlined below. If you have extenuating circumstances, please contact the JCA recruitment office JCA@butler.edu or Wendy Schrepferman in the Butler Theatre department, wschrepferman@butler.edu.

PHOTOGRAPHIC AND/OR VIDEO RELEASE FORM FOR PARTICIPANTS UNDER 18
I grant permission to Butler University and its officers, trustees, employees, agents, students, representatives, successors, licensees and assigns (“the University”) to photograph and/or videotape my child’s image, likeness, or depiction. I grant permission to the University to edit, crop, or retouch such photography and/or video footage, and waive any right to inspect the final production. I consent to and permit photographic and/or video representation of my child to be used by the University worldwide for any purpose, including educational and advertisement purposes, and in any format, including website with or without associating names thereto. I further waive any claim for compensation of any kind for the University’s use or distribution of video footage of my child. I fully and forever discharge and release the University from any claim for damages of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of name, likeness or image) arising out of the use of publication of photographs and/or videos of my child by the University, and covenant and agree not to sue or otherwise initiate legal proceedings against the University for such use or publication on my own behalf. All grants of permission and consent, and all covenants, agreements and understandings contained herein are irrevocable.

PHOTOGRAPHIC AND/OR VIDEO RELEASE FORM FOR PARTICIPANTS OVER 18

I grant permission to Butler University and its officers, trustees, employees, agents, students, representatives, successors, licensees and assigns (“the University”) to photograph and/or videotape my image, likeness, or depiction. I grant permission to the University to edit, crop, or retouch such photography and/or video footage, and waive any right to inspect the final production. I consent to and permit photographic and/or video representation of myself to be used by the University worldwide for any purpose, including educational and advertisement purposes, and in any format, including website with or without associating names thereto. I further waive any claim for compensation of any kind for the University’s use or distribution of video footage of me. I fully and forever discharge and release the University from any claim for damages of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of name, likeness or image) arising out of the use of publication of photographs and/or videos of myself by the University, and covenant and agree not to sue or otherwise initiate legal proceedings against the University for such use or publication on my own behalf. All grants of permission and consent, and all covenants, agreements and understandings contained herein are irrevocable.

Student First and Last Name

Parent/Legal Guardian First and Last Name

Your Signature

Click to Sign...

Today's Date

I acknowledge and represent that I am over the age of 18, have read the entire PHOTOGRAPHIC AND/OR VIDEO RELEASE FORM FOR PARTICIPANTS UNDER 18, that I understand its terms and provision, and that I have signed it knowingly and voluntarily on behalf of my child.

Yes

I acknowledge and represent that I am over the age of 18, have read the entire PHOTOGRAPHIC AND/OR VIDEO RELEASE FORM FOR PARTICIPANTS OVER 18, that I understand its terms and provision, and that I have signed it knowingly and voluntarily.

Yes