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 gave my child permission the rights to leave the program unescorted? (Please select “Yes” or “No” below)
YesNo
My child will be picked up by parent, legal guardian or other: _____________________. 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.
