The Young Americans Performing Arts Workshop Waiver
Thank you for your interest in The Young Americans Performing Arts Workshop at Shotton Hall Academy. Please fill out the following information.
Sign in to Google to save your progress. Learn more
Student First Name *
Student Last Name *
Student Email
Parent First Name *
Parent Last Name *
Parent Email *
Address *
City/Town *
County *
Country *
Postal Code *

It is understood that The Young Americans’ Music Outreach program is a voluntary program that includes physical and mental activity. Although The Young Americans will do its best to prevent personal injury from occurring to the participants, it is possible injuries may occur. By signing below, I voluntarily, on behalf of myself and my son and/or daughter (collectively, referred herein as “Participant(s)”), HEREBY RELEASE, WAIVE, RELINQUISH, AND DISCHARGE The Young Americans, Inc., its officers, directors, employees, agents, students, and members, along with any other sponsors or promoters, and owners, and lessees of premises used to conduct the event, their officers and employees, officials and volunteers assisting in the event, the sanctioning organization, or any subdivision thereof; all for the purpose herein collectively referred to as “releasees,” from all liability to the undersigned, including any personal representatives, assigns, heirs, and next of kin, for any and all loss or damage, and any claims or demands, for personal injury, property damage, or wrongful death, arising as a result of Participant(s) engaging in or receiving instructions in said activity, or activities, incidental to The Young Americans’ program, wherever or however the same may occur and for whatever period said activities may continue, whether caused by the negligence of the releasees, or otherwise. IT IS PARTICIPANT(S)’ INTENTION BY THIS INSTRUMENT, TO EXEMPT, RELEASE AND HOLD ABSOLUTELY HARMLESS THE RELEASEES FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH, CAUSED BY NEGLIGENCE THAT MAY OCCUR TO PARTICIPANT(S).

Participant(s) hereby authorize The Young Americans and its members, employees, sponsors, supporters, grantors, agents, or affiliated entities/agents (collectively, “YA”) to take and/or use photographs, video, and/or audio taken of Participant(s) during the program and consent to the use of Participant(s)’ likeness and image in any and all publications, educational materials, research, advertising, news media, and World Wide Web materials.

Participant(s) further grant permission to use of Participant(s)’ image, likeness and sound of Participant(s)’ voice as recorded on audio and/or video tape without payment or any other consideration. Participant(s) understand that Participant(s)’ image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein Participant(s)’ likeness appears. Additionally, Participant(s) waive any right to royalties or other financial compensation or other remuneration arising or related to the use of Participant(s)’ image or recording, either for initial or subsequent transmission or playback.

Participant(s) understand and agree that such materials, including all negatives, positives, digital images, and prints shall become and remain the sole property of YA and Participant(s) shall have no right or title to such items. I further understand and agree that these materials may be kept on file and used by YA for potential future purposes and further agree to release YA from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials.

This consent and release does not expire, nor is there any geographic limitation on where these materials may be distributed. This release applies to photographic, audio or video recordings collected as part of the YA program to which this document relates. By signing this release Participant(s) understand this permission signifies that photographic, audio or video recordings of Participant(s) may be electronically displayed via the Internet.
I have completely read and fully understand the above release and agree to be bound thereby. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Young Americans. Report Abuse