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Authorizations
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Parent's Full Name: *
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Parent's Cell Number: *
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Student's Full Name: *
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(1), (We) the undersigned, parent(s) of: *
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a minor, do hereby authorize an instructor of Green Room Theatre Academy as an agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any accredited hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. *
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It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician is the exercise of his/her best judgement may deem advisable. This authorization shall remain effective through July 25, 2018. *
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Insurance Carrier: *
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Group Number:
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I.D. Number *
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By typing parent name here, you signify you have read and are authorizing all information is true to your knowledge: *
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During our class sessions, rehearsals, and performances, we may be videotaping and photographing our students. Some images may be used for promotional purposes (our website and published material). Other images may be used for news articles or educational purposes. No names will appear on promotional (advertising) materials. Some of our productions will be sent to you by internet that is on a private Youtube posting. Fees will be not be paid to the photographed or videotaped subjects. We are proud of the work students have achieved and would like to capture some of their magic so you and others can see how great the actors' work really is. I have read the above explaining videotaping procedures and: *
Video DVD Offer - We ask that you refrain from flash photography and videotaping during the show, as the cameras can be distracting to actors and audience. Please save photo session for after the show. *
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Every family will receive ONE free edited DVD to their home about 4-6 months after the show. If you would like any ADDITIONAL DVDs at $20 each, please indicate below. Please send a check for the proper amount.
$20
$200
STRIKE - set breakdown procedures. Striking the set is one of the most team-oriented activities in the theatre process. When the last show is done, everybody stays to dismantle the set, pack it up, and return everything to normal. We ask that all parents and actors stay for strike. Some of our equipment is borrowed from different places, and costumes need to be packed up. Everything needs to get broken down and returned to the right destination - we need to be out of the venue by the designated closing time. Some tasks are more complicated, but most of them are very easy and just require packing up, loading, and driving to a specific place at the end of the night. We also need parents who have vehicles, trailers, or trucks to help deliver some loads to different places after performance. This is a big task, but when everyone pitches in, it goes quickly. We appreciate all of your help GREATLY! *
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I agree to stay for strike of set on final performance night (please include your full name, email, phone number, and let us know if it's okay to text):
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You are done with 3 out of 4 forms. You are about to proceed to Summer Theatre Conservatory Registration 4. When you click on Submit, you will proceed to a blank screen. Please scroll up to the TOP to find link to Google Form 4. I have read and understand I need to fill out 1 more form and then submit payment: *
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