EmailMeForm
Class/Camp Location
Everett
Issaquah
Select one.
Student Name
*
First
Last
Student Birthdate
*
mm/dd/year
Parent/Guardian Name
First
Last
Current Enrollment Session
Fall
Winter
Spring
Summer
A new form must be completed each session that media abstention is desired.
RELEASE OF LIABILITY AND HOLD HARMLESS: (By entering parent/guardian's First and Last Name, you agree to the following statement.
In the event of an accident or illness, I understand that every reasonable effort will be made to contact parent/guardian immediately. However, if I am unavailable, I authorize the KIDSTAGE staff to secure emergency medical care for my child as needed. Although I understand that KIDSTAGE will make every reasonable effort to provide a safe environment, I am fully aware of the special dangers and risks inherent in participating in theatre arts, which may include physical injury or other consequences arising or resulting from the program. I also grant permission for KIDSTAGE staff to take my child off site (within walking distance of the theatre).
Being fully aware of these risks, I hereby consent to my child's participation in this program and agree to hold Village Theatre and KIDSTAGE staff harmless in any event.
MEDIA NOTICE: (By entering parent/guardian's First and Last Name you agree to the following statement.)
I, being the legal guardian of the program participant named above, do also understand that Village Theatre has permission to use his/her name, photograph, likeness, video or voice recording for broadcast or publication in any and all media. I further understand that if I wish to withhold permission for these usages, I must submit a Media Abstention form available through the KIDSTAGE office.
