M.Y.A.I. Membership Application
Welcome to Memphis Youth Arts Initiative Online Registration Form! Use this form to pre-register your child for our performing arts program. We have other paperwork that must be completed in person, but this form will grant your child access and permission to attend practices and events after confirmation is submitted. Contracts and Cost of this program are discussed in person. Application Fee is $10 and can be paid on child's first day, via CashApp to $MYAI19 (Trinika Dodson), or directly on our website using credit/debit card at www.memphisyoutharts.org

Email address *
Performing Child's NAME *
Performing Child's T-SHIRT SIZE *
Performing Child's GRADE *
Performing Child's AGE *
Parent #1 First & Last Name *
Parent #1 PHONE NUMBER *
Parent #2 First & Last Name
Would You like to order a Memphis Youth Arts Initiative T-Shirt for Myself or Other Family Members? *
Parent/Family T-Shirt Size #1 (Adult Sizes)
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Parent/Family T-Shirt Size #2 (Adult Sizes)
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Parent/Family T-Shirt Size #3 (Adult Sizes)
If you need more than 3 shirts, please call (901) 233-9697 P-Chic Styles
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Child(s) Home Address *
Street Number, Name, City, State, & Zip Code
Choose Performing Art Child has Interest In *
Please choose the art that your child is MOST interested in. There will be an opportunity to try other arts or participate in more than one. This questions needs to be answered to the best of your ability because space is limited in some arts.
Child's Doctor Name & Phone Number *
Does the Child have any medical conditions or allergies that we should be aware of? *
List any Medications that the child takes on a regular Basis and Dose Amount. *
Can your child adequately perform strenuous extreme exercise, long periods of standing, and being exposed to outdoor elements without complaint? *
We are a very active program and must require students to be physically fit to perform throughout the year. Children often use excuses to try and rid them selves of participating in the activities they don't like but we encourage you to trust un in our decision making and monitoring of health to push children to a physical limit they may have never been to before. This must happen in order to have them physically ready for the type and intensity of the the performances we are invited to and participate in.
Application Signature and Agreement *
I, (The applicant) the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS MEMPHIS YOUTH ART INITIATIVE their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Released from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted by law. PLEASE TYPE YOUR FIRST AND LAST NAME BELOW TO COMPLETE APPLICATION AND ACCEPT AGREEMENT.
A copy of your responses will be emailed to the address you provided.
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