Student Name:*
Student Age: *
Select Your Summer Program(s):*
Address:
Name of Student's School
Student Gender:*
Student Ethnicity:
Guardian Name:*
Guardian E-mail:*
Guardian Phone:*
-
Second Guardian Name (as applies):
Second Guardian Email:
Second Guardian Phone:
-
Please provide any medical information we should know about while your student is with us:
If your student has differing abilities, please let us know if there are any insights we should be aware of, or accommodations we can make, for your student's best experience. Or write "Please contact me to arrange" so we can discuss a personalized plan.
Emergency Contact (if Guardians are unavailable)*
Emergency Contact Phone:*
-
I would like to inquire about before/after care. *
I will pay for the program by:*
My child has permission to participate in Children’s Theatre Workshop. CTW has the right to use photos of my child for promotional purposes. Photos could be from classtime, rehearsals, performances, etc. I understand that in the event of an emergency, every effort will be made to contact the people named above, but CTW reserves the right to exercise judgment in calling 911 in the case of an emergency. I understand that my child’s participating in CTW is potentially hazardous, and I assume full and complete responsibility for any injury or accident which may occur while my child and I are traveling to or from CTW events, during CTW events, or while I am on the premises of a CTW event. I am also aware of and assume all risks associated with my child’s participating in CTW and CTW’s events. I understand and agree that in consideration of my child’s being permitted to participate in the event, that I, for myself, my child, and my heirs and executors, hereby waive, release, and forever discharge CTW, and its directors, agents, representatives, successors, and assigns, and all other persons associated with CTW and a CTW event, from all liabilities, claims, actions, or damages that I or my child may have against them, arising out of or in any way connected with my child’s participation in CTW. I understand that CTW expressly disclaims all warranties of any kind, express or implied. I acknowledge and agree that I am signing this Agreement and Waiver freely and voluntarily, and intend my acceptance to be a complete and unconditional release of all liability to the greatest extent allowed by law. I further understand that the fee is non-refundable and non-transferable. *
Type what you see; we want to make sure you're not spam!