Legal Guardian and/or Parent of Participant (print full name) *


Mailing Address *


City *


State *


Zip Code *


Home Phone *


Cell Phone *


Work Phone


Email *


Participant (print full name of student) *


Age *


Gender *
Male
Female

Camp/Class (choose one) *
Mermaid Camp Action Camp Creature Camp Voice Camp Shakespeare Camp Musical Theatre Camp Youthstage production of Taming of the Shrew

Program: THE CHILDREN’S THEATRE, THEATRE SCHOOL PROGRAMS I, the undersigned, am the parent and/or legal guardian ("Parent/Guardian") of the minor Participant named above. PAYMENT/REFUND POLICIES •Tuition will be due ON OR BEFORE THE FIRST DAY OF CLASS. If tuition is not paid, student will not be allowed to attend class. Any checks with insufficient funds will incur a $30.00 “bounced check fee”. •75% refund after the 1st day of class and 50% after 2nd class NO REFUNDS after the 2nd day of class TERMS AND CONDITIONS I authorize the Participant to participate in the above program at the The Children’s Theatre (TCT) locations. I understand that such participation can include foreseeable and unforeseeable risks and other hazardous activities inherent in the program that may expose the Participant to illness, injury, or death. Parent/Guardian of Participant freely and voluntarily allows participation in the program with the knowledge of the danger involved and hereby agrees to assume and accept any and all risk of injury or death. PARTICIPATION WAIVER, RELEASE, AND INDEMNIFICATION Parent/Guardian of Participant understands and acknowledges that the The Children’s Theatre (TCT) are not an insurer of Participant's behavior, actions or participation in the program, and that TCT assume no liability whatsoever for personal injuries or property damages to Participant or to third persons arising out of participation in the program activities. Parent/Guardian of Participant hereby agrees to release, waive, covenant not to sue, indemnify and hold harmless TCT, and all of their officers, employees and agents (collectively the "Releasees") from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by Participant or loss or damage to any property belonging to Participant arising out of or related to participation in the above named Program, and excepting only such loss, damage or injury as may be caused by the sole negligence of any Releasee. Parent/Guardian of Participant agrees that the site of any lawsuit arising out of or related to participation in the Program shall be Utah and that this Agreement will be governed by and construed in accordance with the laws of the state of Utah, without application of any principles of choice of law. By signing this agreement, you are verifying the following: • Participant does not have any medical conditions that would prevent participation in Program. • Participant has adequate health insurance to cover the costs of treatment in the event of any injury. • Participant shall pay any attorney fees or costs incurred by The Children’s Theatre in enforcing this Agreement. If any portion of this Agreement is held to be invalid by a court of law, then it is agreed and intended that all the remainder shall, notwithstanding, continue in full force and effect. PARENT/GUARDIAN OF PARTICIPANT HAS CAREFULLY READ THESE TERMS AND FULLY UNDERSTANDS THEIR CONTENT AND IS AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN PARTICIPANT OR PARENT/GUARDIAN OF PARTICIPANT AND THE RELEASEES AND SIGNS IT OF HIS OR HER OWN FREE WILL. Parent/Guardian Authorization: The person herein described has permission to engage in all camp activities except noted. I hereby give permission to TCT to seek emergency medical treatment on behalf of the Participant. I am signing this Agreement on behalf of a minor Participant. I acknowledge that I am the Parent/Guardian of the Participant and that I understand the terms of this Agreement. I also acknowledge that these terms shall bind my heirs and personal representatives and the heirs and personal representatives of Participant. PLEASE CHECK THE BOX TO AGREE TO THE TERMS ABOVE. *

PHOTO RELEASE. I authorize the The Children’s Theatre to take and use without payment any photographs, slides, or video-tape of my child as may be needed for public relations, marketing/advertising in print or on our website, or internal training purposes. Please note that if a child’s photo is used in any manner by The Children’s Theatre, their name will not be used and, if necessary, any identification of name will be shaded out. PLEASE CHECK THE BOX TO AGREE TO THE TERMS ABOVE. *
Yes No

CODE OF CONDUCT. Never harass, demean or mock other students or teachers. Use of illegal drugs is forbidden. Use proper language and conduct around other students and teachers. No inappropriate touching of other students/teachers. Students participating in all classes should wear clothing and footwear to facilitate movement. Hair should be pull ed back and jewelry, hats, or other distractions should be avoided. No “short shorts” or tank tops. Vulgar symbols or lettering on clothing is not permitted. No gum is allowed in class. Students breaking any of the code of conduct rules will have the following disciplinary actions: 1st instance - student will be given a verbal warning by the teacher(s). 2nd instance – student will be given a verbal warning, and parent/guardian will be contacted. 3rd instance – student will be dismissed permanently from class/camp. PLEASE CHECK THE BOX TO AGREE TO THE TERMS ABOVE. *
Click to agree.

Emergency Medical Authorization Fill out one form per person. All lines must be filled out. In the event of a non-emergency medical situation, the parents or designated alternates will be contacted for further instructions. Listed below are the emergency procedures for the The Children’s Theatre. In the event that your child needs emergency medical attention, the following steps will be taken: Parents will be contacted for further instructions. If contact with parents is unsuccessful, The Children’s Theatre will contact the designated alternates listed above. If contact with designated alternates is unsuccessful, the emergency medical personnel will make a decision deemed appropriate in the treatment of your child. I have read and understood The Children’s emergency procedures and authorize The Children’s Theatre to take the above listed steps for emergency and non-emergency medical situations. PLEASE CHECK THE BOX TO AGREE TO THE TERMS ABOVE. *
Click to agree.

List any medications your child is taking


Allergies (food, medical, etc.)


Activity Restrictions or Precautions


List any special needs or important information about your child’s medical history/behavior


List 2 alternate people who may be contacted if your child should become ill or injured (Names and phone numbers)


Pick-Up Amendment If you feel comfortable having your child leave The Children’s Theatre’s doors without an authorized pick-up signature please indicate below. By checking “my child may exit without an authorized pickup”, it removes The Children's Theatre from any responsibility regarding your child once they have left our theatre. *
Yes, my child may exit without an authorized pickup
No, my child needs an authorized individual to pick him/her up

To ensure the safety of your child at The Children’s Theatre, list any individuals, other than yourself, that are authorized to pick-up your child before and/or after theatre school. Please note that individuals not listed on this form will not be allowed to sign your child in or out for theatre school.


Signature of Legal Guardian and/or Parent of Participant (please type name) I declare, under penalties of perjury and as an authorized parent/guardian, that this registration has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete. By typing your name in the indicated fields, you are agreeing to conduct business electronically with The Children's Theatre in accordance with the federal Electronic Signatures in Global and National Commerce Act (E-Sign), 15 U.S.C.A. § 7001-7031 (Supp. 2001) and Utah's Uniform Electronic Transactions Act (UETA), Utah Code Ann. § 46 4-101 to -501 (2000). Understand that transactions and/or signatures in records may not be denied legal effect solely because they are conducted, executed, or prepared in electronic form, and that if a law requires a record or signature to be in writing, an electronic record or signature satisfies that requirement. *


Date *


Subject: *


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