Blanket Fort PA Day (Dec. 6, 2019)
Join us for a fun-filled day of building forts, craft making and board games! Ages 6-12
Email address *
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Pronoun
Your answer
Child's Age
Your answer
Parent/ Guardian Full Name
Your answer
Full Mailing Address (Invoice Purposes)
Your answer
Phone Number
Your answer
Emergency Contact
Your answer
Emergency Contact Phone Number
Your answer
Does Your Child Have any dietary restrictions or allergies?
Your answer
Are there any access needs, challenges, anxieties/fears that staff should be aware of?
Your answer
Please note invoices will be issued. Please refrain from sending payments until invoice is received.
Invoices can be paid via Email Money Transfer, and Gift Certificate
Please Confirm Fees applicable with this application form
Release Statement
I am the parent or legal guardian of the child mentioned above (the “Student”), who is under 18 years of age. I agree that the Student participate in the full school programs and activities (the “Activities”) of the Drama school of Roseneath Theatre (the “Theatre”). I acknowledge that I must advise the Theatre in writing if the Student is not physically fit to participate fully in the Activities. I also acknowledge that there are risks in participating in the Activities. I agree that, having taken such precautions as in its discretion are deemed advisable, the Theatre will not be held responsible for any injury, sickness or accident to the Student or for any loss or damage to personal property resulting from the Student participating in the Activities. I authorize the Theatre to secure medical care for the Student. If for any reason the Student requires medical attention beyond any first aid furnished by or on behalf of the Theatre, I agree to be responsible for any expenses incurred. I agree to indemnify the Theatre, its officers, directors, agents and employees and save them harmless from and with respect to all suits, actions and prosecutions by reason of any Activity carried out by the Student, whether on or off the Theatre’s property.
Do you agree with this release statement?
Media Release
I consent to the use of the likeness (including still photographs and video) of the Student in connection with the drama programs of the Theatre and related institutional promotional purposes throughout the world and without any compensation. I expressly release the Theatre, its officers, directors, agents, employees, licenses and assigns from and against any and all claims for invasion of privacy, defamation, infringement of copyright or any other cause of action that may arise out of such use. I hereby irrevocably release the Theatre from any and all claims for libel and invasion of privacy in connection with the foregoing.
Do you consent to the use of photography and video?
Thank you for Registering!
Invoices and confirmation email will be sent out 1-3 business days of registration.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Roseneath Theatre. Report Abuse