DOPE: RTSBHI 2019 Registration Form
Participant Information
Email address *
Name *
Your answer
Participating As *
Required
Gender *
Required
Please Select Workshops (STUDENTS) *
Please select 2 workshops ONLY. Space is limited and is on a first come first serve basis.
Please Select Workshops (STUDENTS) *
Please select 2 workshops ONLY. Space is limited and is on a first come first serve basis.
Age *
Your answer
School *
Your answer
Address *
Your answer
Email *
Your answer
Phone *
Your answer
Parent/ Gaurdian Name *
Your answer
DISCLAIMER *
WAIVER CONSENT FORMI. Student’s Release of Liability - I plan to voluntarily participate in RTSBHI, I understand that all reasonable safety precautions will be taken at all times by the leaders and staff during the aforementioned activities and events. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Diverse A.R.T Center, its teachers, employees, officers, directors, or volunteer staff liable for damages, losses, diseases, or injuries sustained.II. Parental Consent – I/We voluntarily permit our child, who is under 18 years of age, to participate in Rock the school Bells HI I/We understand that all reasonable safety precautions will be taken at all times by the leaders and staff during the aforementioned activities and events. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold Diverse A.R.T Center, its teachers, employees, officers, directors, or volunteer staff liable for damages, losses, diseases, or injuries sustained.III. I/We, consent that the photographs, artwork, audio, video, or writing submitted may be used by Diverse A.R.T Center, its assigns or successors, in whatever way they desire, including television, CD‐ROMs, web page, publications, and any other form for the storage, reproduction of information, images; furthermore, I hereby consent that such information, photographs, videos, and the plates and/or tapes from which they are made shall be their property, and they shall have the right to sell, duplicate, reproduce and make other uses of such information, photographs, videos, recordings, and plates as they may desire free andclear of any claim whatsoever on my part. By Sining this form, you agree to the terms and conditions of this agreement. Please complete the following:1. Print all of the following legibly. Use blue or black ink. 2. Check the boxes below. 3. Sign this form.I hereby give my permission to the Diverse A.R.T Center (DAC) to use my child’s work, videotape, or otherwise record my child’s name, voice,and/or likeness in its publications. I understand that examples of my child’s work and/or these recordings of my child will be used commercial, educational purposes, which may include, but not limited to, distribution by print, internet, or digital media and open-circuit broadcast, closed-circuit, and/or cable television transmission within or outside of the State of Hawaii for the duration of the media.I understand that there will be no financial or other remuneration for use of my child’s work and/or recordings, either for initial or subsequent transmission or playback, and I hereby release DAC from any liability resulting from or connected with the publication of such work. Permission is granted for the duration of the media. I further understand that my permission or consent may be rescinded; however, in order for the revocation of permission/consent to be effective, it must be made in writing and said revocation will not affect the publication or work that has already been produced.DAC may use my child’s name, likeness, work, and/or bibliographical identification for publicizing and promoting the use of these recordings. DAC has permission to videotape or otherwise record my child’s name, voice, and/or likeness for commercial/educational purposes.DAC has permission to use my child’s work for commercial/educational purposes.
Required
Parent / Gaurdian Signature *
Your answer
Participant Signature *
Your answer
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