Contact Information, Parental Disclaimer & COVID Waiver
This form is valid for any classes, camps, workshops, cast & crew participation for the 2020-2021 season (July 2020-June 2021).
In order to keep all of our records up-to-date with signed COVID-19 agreements, we need new paperwork from you for each semester, even if you already filled out paperwork for a previous semester.
Class/Camp/Workshop your child is enrolled *
Required
Will you be using early drop-off/late pick-up? *
If you have not already, make sure you purchase your early drop-off/late pick-up per camp at www.spartanburgyouththeatre.com/summerpickup.
Contact Information
Student First *
Student Last *
Student Gender *
Student Grade *
Age *
Student Date of Birth *
MM
/
DD
/
YYYY
Student Email Address *
Student School *
Student Home Phone *
Student Cell Phone *
Home Address *
City *
State *
Zip Code *
Parent/Guardian 1 First Name *
Parent/Guardian 1 Last Name *
Parent/Guardian 1 Email *
Parent/Guardian 1 Cell Phone *
Parent/Guardian 1 Work Phone *
Parent/Guardian 2 First Name
Parent/Guardian 2 Last Name
Parent/Guardian 2 Email
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Work Phone
Emergency Contact Name *
Emergency Contact Relationship *
Emergency Contact Cell Phone *
Emergency Contact Home Phone *
Emergency Contact Work Phone *
Allergies/Medical
Please list any medical conditions/allergies that your child has that we should be aware of *
SYT has permission to administer ibuprofen/Tylenol to my child *
Parental Disclaimer
Thank you for volunteering or participating with The Spartanburg Little Theatre and Spartanburg Youth Theatre. Our insurance policy requires that we have an accurate record of all volunteers. This is an annual form where you agree to release The Spartanburg Little Theatre and Spartanburg Youth Theatre of all liability while working with either organization. This form is in effect for one year from the signing date.

This Release and Waiver of Liability (the “Release”) executed on the day signed below, in favor of The Spartanburg Little Theatre or Spartanburg Youth Theatre, South Carolina nonprofit corporations, their directors, officers, employees, and agents (collectively, “SLT”). The Volunteer/Participant desires to work as a volunteer or participant for SLT and engage in the activities related to being a volunteer/participant (the “Activities”).

The Volunteer/Participant understands that the Activities may include construction and movement of sets and equipment, working in the SLT offices, and/or participating in special events and fundraisers for SLT. The Volunteer/Participant hereby freely, voluntarily, and without duress executes this Release under the following terms:

Release and Waiver: Volunteer does hereby release and forever discharge and hold harmless SLT and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from Volunteer’s Activities with SLT.

Volunteer understands that this Release discharges SLT from any liability or claim that the Volunteer/Participant may have against SLT with respect to any bodily injury, personal injury, illness, death, or property damage that may result from the Volunteer’s Activities with SLT, whether caused by the negligence of SLT or its officers, directors, employees, agents, or otherwise. Volunteer/Participant also understands that SLT does not assume any responsibility for or obligation to provide financial assistance or other assistance - including but not limited to medical, health, or disability insurance - in the event of injury or illness.

Medical Treatment: Volunteer does hereby release and forever discharge SLT from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment, or service rendered in connection with the Volunteer/Participant’s Activities with SLT.

Assumption of the Risk: The Volunteer/Participant understands that the Activities includes work that may be hazardous to the Volunteer, including, but not limited to, construction, loading and unloading, and transportation to and from picking up supplies and materials.

Volunteer/Participant hereby expressly and specifically assumes the risk of injury or harm in the Activities and releases SLT from all liability for injury, illness, death, or property damage resulting from the Activities.

Insurance: The Volunteer/Participant understands that, except as otherwise agreed to by SLT in writing, SLT does not carry or maintain health, medical, or disability insurance for any Volunteer/Participant. Volunteer/Participant Accident Insurance is provided and is a medical insurance policy which covers accidents involving volunteers on the work site or in other supervised events. Volunteer Accident Insurance pays after the Volunteer’s insurance pays. If the Volunteer/Participant has no insurance, the policy pays up to the limits of coverage. Each Volunteer/Participant is expected and encouraged to obtain his or her own medical or health insurance coverage.

Photographic Release: Volunteer/Participant does hereby grant and convey unto SLT all rights, title, and interest in any and all photographic images and video or audio recordings made by SLT during the Volunteer/Participant’s Activities with SLT, including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

South Carolina Law Enforcement Division (SLED) background check: By providing date of birth, the Volunteer/Participant authorizes SLT to complete a SLED check. SLED checks will be required for any volunteer who may be working with SLT participants under the age of 18.

Other: Volunteer/Participant expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of South Carolina, and that this Release shall be governed by and interpreted in accordance with the laws of the State of South Carolina. Volunteer/Participant agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable.
• I am the parent or legal guardian of the actor, who is under 18 years of age, and desire that the actor participate in a production or a class offered by Spartanburg Youth Theatre (SYT). *
• I acknowledge that I must advise the SYT Director in writing if the actor is not physically fit to participate fully in the activities. I also acknowledge that there are risks in participating in the activities. *
• I agree that, having taken such precautions as in its discretion are deemed advisable, SYT will not be held responsible for any injury, sickness, or accident to the actor or for any loss or damage to personal property resulting from the actor’s participating in the activities. *
• I authorize SYT to secure medical care for the actor. If for any reason the actor requires medical attention beyond any first aid furnished by or on behalf of SYT, I agree to be responsible for any expenses incurred. *
• I agree to indemnify SYT, its officers, directors, agents, and employees and save them harmless from and with respect to all suits, actions, and prosecutions by reason of any activity carried out by the actor whether on or off SYT’s property. *
• I consent to the use of the likeness (including still photographs and video) of the actor in connection with The Spartanburg Youth Theatre and related institutional promotional purposes and without any compensation. *
• I expressly release SYT, its officers, directors, agents, and employees from and against any and all claims for invasion of privacy, defamation, infringement of copyright or any other cause of action that may arise out of such use. *
• I hereby irrevocably release SYT from any and all claims for libel and invasion of privacy in connection with the foregoing. *
Parent/Guardian Electronic Signature *
By writing your full name below, you agree as the student's parent/guardian to all of the terms listed above.
IN WITNESS WHEREOF, Volunteer/Participant has executed this Release as of the day and year first written below: *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy