Mother or Guardian’s name *
Father or Guardian’s name
E-Mail *
Subject *
Parent(s) or Guardian’s Phone Number(s) *
Home Address (street, city, state, zip code)
Other contact person(s) names for emergency
Their contact phone number(s)
Student’s first and last name
Student’s Birth Date & Grade
Does Student have any ailments, restrictions, and/or allergies? Yes or No? Explain:
Release of Liability and Waiver The parent or legal guardian and the Student understand that the course includes activities that may be hazardous to the student, including strenuous physical activity. The parent or legal guardian and the student do hereby expressly assume the risk of injury or harm for participating in the course and release On Stage Productions Inc. From any and all liability or claims that the student may have against OnStage Productions Inc. with respect to any bodily injury, personal injury, or property damage that may result from the student’s participation in the course.
I give my child permission to leave the program unescorted: Yes my child may leave without escort.No my child must be escorted.
My child will be picked up by parent, guardian or other. Name.
The undersigned gives permission to OnStage Productions Inc. its owners and operators to seek medical treatment for the student in event they are not able to reach a parent or legal guardian or designed emergency contact. The student does not have any physical or mental restrictions to participating fully in program except as set forth above.
( Photographic Release ) The student does hereby grant and convey unto On Stage Productions Inc. all rights, title, and interest in any and all photographic images and video or audio recordings made On Stage Productions Inc. During the student’s actives with OnStage Productions Inc. including, but limited to any royalties, proceeds, or other benefits derived from such photographs or recordings.
I agree with photo release statements above with my child. YesI agree with photo releases.
