Child's First Name (required)

Child's Last Name (required)

Child's Age (6 and up) (required)

Child's Birthday (required)

Child's School (required)

Parent First Name (required)

Parent Last Name (required)

Parent Email (required)

Parent phone number (required)

Additional emergency contact name and number(required)

I understand that there are risks of physical injury associated with, arising out of and inherent to the activity of theater. In recognition of this acknowledged risk of injury, I knowingly and voluntarily waive all right and/or causes of action of any kind, including any and all claims of negligence arising as a result of such activity from which liability could accrue to The Jewel Box Children’s Theater Company Inc, its officers, agents, employees, instructors, subsidiaries, parent corporations, and all affiliated entities (hereinafter collectively referred to as “The Jewel Box Children’s Theater Company”. In consideration of participation in the activity of theater classes I hereby agree to release The Jewel Box Children’s Theater Company and hold The Jewel Box Children’s Theater Company harmless of all liability to the extent permitted by law, and hereby acknowledge that I knowingly and voluntarily assume full responsibility for all risks of physical injury arising out of active participation in theater on behalf of the participant. I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation. The participant has my permission to participate in The Jewel Box Children’s Theater Company. I warrant the below information is complete and correct. This contract is governed under the laws of the state of California. (Please initial below)

I, the parent or legal guardian of child above, grant The Jewel Box Children’s Theater Company permission to use the photographs and video for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use. In addition I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. (Please initial below)

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