Story2Stage Registration & Photo Release
Please fill in the appropriate information for the Ebony Road Players Story2Stage Fall Theatre Camp
Date: EVERY SATURDAY from Oct 5th-Dec 14th Time: 9am-12:00pm
Location: Wealthy Theatre Annex: 1110 Wealthy St SE
Camper's Name *
Your answer
Parent/Guardian Name *
Your answer
Address *
Your answer
City/State/Zip Code *
Your answer
Email *
Your answer
Grade for 2019-2020 School Year *
Your answer
School District *
Your answer
Emergency Contact Phone Number *
Your answer
Photo Release Information
I, as the parent/guardian of the Camper listed above, hereby grant Ebony Road Players ("Theatre Company") the absolute right and permission to use photographic portraits, pictures, digital images or video recordings of the Camper, or in which My Child may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any publication or on the "Theatre Company" websites, without payment or any other consideration and do hereby waive any right to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein The Camper's likeness appears, or the use to which it may be applied.

I hereby release, discharge, and agree to indemnify and hold harmless the "Theatre Company" from all claims, demands, and causes of action that I or the Camper have or may have by reason of this authorization or use of the Camper's photographic portraits, pictures, digital images or video recording, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said images or video recordings, or in processing tending towards the completion of the finished product, including publication on the internet, in brochures, or any other advertisements or promotional materials.

I represent that I am at least eighteen (18) years of age and am fully competent to sign this Release.
By filling in my name below, I hereby agree that I have read and consent to this photo release. *
Your answer
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