Register for Rappahannock Lions Variety Show

Contestants Name(s):

Parent or Guardian (if applicable):

Address:

Phone:

Email Address

Will a piano, other musical instruments, or props be needed? Will a piano, other musical instruments, or props be needed? Yes No

School (if applicable):

Number of people participating in act:

Type of Act (vocal, musical instrument, comedy, dance, other — please note animals and pets not permitted):

Length of act (not to exceed five minutes):

So we can introduce you to the audience, please tell us one or two things about you and your act:

I understand the talent show is a “family friendly” performance and agree that profanity, off-color remarks and politics will not be part of my act. I understand the talent show is a “family friendly” performance and agree that profanity, off-color remarks and politics will not be part of my act. Yes

I give permission to be photographed at the talent show for publicity purposes: I give permission to be photographed at the talent show for publicity purposes: Yes No