Theatre Guild Contact and Waiver Form
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's School ID # *
Your answer
Student's Email *
Your answer
Student's Mobile # *
Your answer
Student's Address *
Your answer
Student's High School *
Your answer
Student's Previous Schools
Your answer
Grade *
Parent/Guardian #1 First Name *
Your answer
Parent/Guardian #1 Last Name *
Your answer
Parent/Guardian #1 relationship
Your answer
Parent/Guardian #1 email *
Please use an email address that is checked regularly
Your answer
Parent/Guardian #1 mobile # *
Your answer
Parent/Guardian #1 address *
Your answer
Parent/Guardian #2 First Name
Your answer
Parent/Guardian #2 Last Name
Your answer
Parent/Guardian #2 relationship
Your answer
Parent/Guardian #2 email address
Please use an email address that is checked regularly
Your answer
Parent/Guardian #2 Mobile #
Your answer
Parent/Guardian #2 address
Your answer
Emergency Phone Number *
Your answer
Internet Waiver *
We are providing this parental consent form to both inform you and to request permission for your child's photo/image and name to be published on the Pioneer High School Theatre Guild website. As you are probably aware, there are potential dangers associated with the posting of personally identifiable information on a website since global access to the internet does not allow us to control who may access such information. These dangers have always existed; however, we as schools do want to celebrate your child and his/her work on our website. The law requires that we ask for your permission to use information about your child. Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information includes student names, photos or image, email addresses, phone numbers, and locations and times of Theatre Guild events.
Required
Signature of Parent/Guardian (Liability Waiver) *
Pioneer Theatre Guild involves certain inherent risks, dangers and hazards which can result in serious personal injury. The student/participant (and/or the student/participant’s parent or legal guardian) assume and accept all risk of injury while participating in the activity. All participants agree to abide by the rules and acknowledge that they participate at their own risk. At all times, the participant (and/or participant’s parent or legal guardian) shall be fully liable for personal injury and property damage incurred while on school property and the participant (and/or the participant’s parent or legal guardian) agree to defend and hold the district and it’s employees harmless against any and all liability for claims, demands and causes of action asserted against the district arising from the participant’s use of the facilities or otherwise upon the premises.
Your answer
I have checked over the above information, and I certify that it is correct *
Required
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