To be eligible to attend “Theater Studio Debut”, participants must complete this Registration Form and our Medical Release Form along with the Medical Care Authorization and Waiver and Release Liability from Theater Studio Debut (all of these requested via email: email@example.com)
Return this completed form to: Theater Studio Debut
Participants Name: ___________________________________
DOB: _________________ M_____ F_____ Grade______
Home Phone Number: ____________________________________________________
Father’s Name: _____________________ Phone Number: _______________________
Mother’s Name: _____________________ Phone Number: ______________________
Emergency Contact Name:________________________________________________
How did you hear about our theater? _________________________________________
Please list any allergies or medical conditions that we should be aware of: ______________________________________________________________________
List any other information that you think would be valuable for DEBUT STUDIO staff to be aware of that would make your day with us more enjoyable for you:
Release of liability:
I hereby release and hold harmless Theater Studio Debut, its staff, employees, agents, representatives, volunteers, heirs, executors, and assigns from all liability for personal injury, including death, as well as all property damage or loss arising out of my/my child’s participation in this Program. I understand that this release and indemnification release liability for their conduct of Theater Studio Debut and its officers, employees, agents, representatives, volunteers, heirs, executors and assigns. I/we understand that my child’s participation in Theater Studio Debut programs is voluntary and that my child and I/we are free to choose not to participate.
Photo Release: The undersigned gives permission to Theater Studio Debut to use photographs and audio and/or video recordings of participants for fundraising and/or marketing purposes. On occasion, with permission, Participant photographs may be included in promotional videos, websites, social media, albums, newsletters or our Information Poster, which contain information given to general public. Theater Studio Debut respects the privacy of its Participants and does not allow unauthorized visitors to photograph or video or its Participants.
Participants Consent: The undersigned gives permission for the Participants in any and all activities to and from for activities, expect specifically prohibited by the participants physician or parent/legal guardian.
General Program Registration & Waiver Form: I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnify Theater Studio Debut, their employees, officers and agents, from any loss, cost, damage and/or expense of any nature, including all attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s participation in Theater Studio Debut voluntary programs or activities. I/We give permission for our son/daughter to participate in all activities, and do forever release Theater Studio Debut and its teachers, staff, volunteers and agents from any and all actions, all known and unknown personal injuries or property damage of said minor arising out of said activities, and also all claims or right of action for damages which said minor has or hereafter may acquire.
I also have made arrangements to secure timely pick up of my child at the conclusion of each scheduled program event, meeting, rehearsal or performance. I also understand that the Late Fee policy will apply
By signing this Agreement, I/we acknowledge that we have read and understand this document and accept the risk and responsibility of participation in interscholastic or other voluntary after school athletics.
Parent’s Signature: ___________________________________Date: ______________
In the event of an emergency, I hereby certify that I am the parent/lawful guardian of _______________________________________, and grant to Theater Studio Debut, its employees and agents full authority to take whatever action they may consider appropriate under the circumstances involved regarding the health and safety of my child and authorize them to obtain emergency medical or dental services for my child, if necessary, at my expense.
Parent’s Signature: ______________________________________________________
Date: _________Emergency Phone #: _______________