Theatre Arts School of San Diego
REGISTRATION AND RELEASE FORM
Student's First Name *
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Student's Last Name *
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Student Email
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Date of Birth *
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Are you currently enrolled in school? *
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If so, please list school name.
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Home Address *
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#1 Parent / Guardian Name (if minor)
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#1 Parent / Guardian Email
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#1 Parent / Guardian Phone
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#2 Parent / Guardian Name (if minor)
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#2 Parent / Guardian Email
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#2 Parent / Guardian Phone
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#1 Emergency Contact Name *
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#1 Emergency Contact Phone *
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#2 Emergency Contact Name *
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#2 Emergency Contact Phone *
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I am registering for: *
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Do you have any allergies? *
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If so, please explain:
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Do you have medical needs or require any special assistance? *
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If so, please explain:
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Goals you are looking to accomplish in the next 6 months: *
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Do you carry an Epi Pen, and if so, where do you keep it? (Example: front pocket of backpack)
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Please list related theatre arts experience: *
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RELEASE OF LIABILITY
I understand that participation in any programs at THEATRE ARTS SCHOOL OF SAN DIEGO, LLC may expose Students to activities and equipment which could cause accidents and injuries. I also understand that Students will not be supervised outside of scheduled class or rehearsal time. In consideration of Enrolled Student’s acceptance into THEATRE ARTS SCHOOL OF SAN DIEGO, LLC programs, I hereby release, waive, discharge, indemnify and hold harmless THEATRE ARTS SCHOOL OF SAN DIEGO, LLC, its owners, directors, officers, employees and agents, from and against any claim for damage, injury, loss or death to the Enrolled Student resulting from participation in any class, program, play or other activity either at the School or at another location including any damage, loss or injury resulting from any failure to abide by the rules as explained to the Enrolled Student by The THEATRE ARTS SCHOOL OF SAN DIEGO, LLC staff upon onset of activity.
I have read and understand the Release of Liability (please initial and date) *
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HEALTH CARE AUTHORIZATION
I hereby authorize THEATRE ARTS SCHOOL OF SAN DIEGO, LLC staff to do any act which may be necessary or proper to provide emergency health care for the Enrolled Student in the event that the Parent/Guardian/Emergency Contact cannot be reached, including consent to and authorization of medical procedure by physicians, dentists, hospital or other emergency medical personnel, as they, in the exercise of their sole discretion, may deem necessary. I understand that I am responsible for all costs and expenses of such medical treatment.
I have read and understand the Health Care Authorization: (please initial and date) *
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PHOTO RELEASE
I, do hereby grant or deny permission to The THEATRE ARTS SCHOOL OF SAN DIEGO, LLC to use the image of the Enrolled Student as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the web site.
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I have read and understand Photo Release (please initial and date) *
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