Cirque Goes Broadway Trip

Student Name *

First Name

Last Name

Student Phone Number

If the student does not have a phone number, please leave blank.

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Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

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I understand the Cincinnati Music Hall requires all participants 12 years of age and older to show proof of COVID-19 vaccination or a negative COVID-19 test. In addition, participants are required to wear a mask at all times in the music hall. UYC will offer FREE rapid COVID-19 tests on the morning of the trip and FREE masks for participants who need them.

Yes, the student will follow the requirments.

No, the student will not follow the requirements.

Vaccination Status

Fully vacinated student - Student will provide proof of being fully vaccinated for COVID-19 on the day of the trip.

Unvaccinated or not fully vaccinated student - Student will take a FREE COVID-19 rapid test at UYC on the morning of the trip.

Exempted student - Student can provide proof that they are 11 years old or younger on the day of the performance.

The student listed above is a registered UYC student with all parental permissions approved.

Yes

No