Peace March 2018
Please fill this form out so we can best accommodate you for the Peace March on July 27, 2018.
Name
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Age/ DOB
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Address
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Name of Parent(s)/ Guardian
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Home/ Cell/ Work Phone #
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Email for updates about Peace is Possible March 2018
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How did you hear about us?
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Emergency Contact Name/ Relationship to Participant
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Phone # of Emergency Contact
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Allergies, Medical Concerns, and/or Accessibility Needs
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Liability Waver: I ___________________________________________ , waive any claim against the Children’s Peace Theatre, staff, volunteers and guides of any liability for any injury to my child, loss or damage to his/her belongings while involved in any activity sponsored by the Children’s Peace Theatre. I give my permission that, should a medical emergency arise, requiring immediate attention during the time that my child is at the Children’s Peace Theatre, the staff or volunteers may act on my behalf in caring for them, and may give consent for medical treatment on behalf of my child.I have read and agreed to the registration guidelines stated in this form.
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Date of Form Signed/ Filled Out
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Media Waver: I, _________________________________, give Children’s Peace Theatre permission to photograph, videotape, audiotape, film and interview myself or the child/children named below and publish said photographs, videotapes, audiotapes, films and interviews in publications/ printed materials including marketing and promotional materials, and the official website of Children’s Peace Theatre (www.childrenspeacetheatre.org) including marketing for our programmes to the public, members and funders, annual reports and internal communications.The photographs, videotapes, etc. shall constitute the exclusive property of Children’s Peace Theatre and may be reproduced by the above without compensation or payment to the individual (s) concerned or any other person. I understand that my name, portrait, picture or photograph are likely to be included in this collection of images for a maximum of five years.
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