Medical/Photo Release and Behavior Contract
2019-2020 Class Registration Information
**Students without this contract will not be eligible to stay at classes, camps, rehearsals, workdays or productions until all forms are submitted.**

Email address *
I give permission for my child *
Your answer
Date Of Birth *
MM
/
DD
/
YYYY
To Participate in the following- (Please click all that may apply.) *
Required
Parent/Guardian Name * *
Your answer
Address *
Your answer
City, State *
Your answer
Phone Number *
Your answer
Emergency Contact Name and Number *
Your answer
Insurance Company Name *
Your answer
Insurance Company Policy or Member Number *
Your answer
Medical Information (Allergies, Medications..etc) *
Your answer
Adult in charge may give my child tylenol * *
I hereby authorize and consent that CYT shall have the absolute right, without any compensation to my child or me, to copyright, publish, use, sell or assign any and all photographs, portraits or pictures, television spots, movie films, videotapes and/or sound recordings, or any part thereof, that have been taken of my child, or in which my child may be included in whole or in part. * *
In the event of an accident or medical emergency, I give permission to the designated adult supervisor in charge to secure emergency medical treatment for the minor involved. I also agree to hold CYT, and/or their assignees, harmless in the event of an injury or accident. *
Required
Parent Signature- I understand that this is a legal representation of my signature. *
Your answer
I know that participating in CYT is a privilege. I, *
Your answer
Will *
Required
I understand if I do not abide by the rules stated above, there will be consequences. Such as: *
Required
I read and understood the behavior requirements, and I know that any infractions will be documented and may affect future CYT participation. (Type Student Name) *
Your answer
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