Waiver-College Park | apluskidstheatre

Liability Waiver-Summer Camp

First Name

Last Name

Name of child(ren)

Birthday

Emergency Name & Phone

Family Doctor & Insurance Company

Allergies, Medical Conditions and/or Medications

Please specify anything we should know about

As the parent/guardian of the above minor, I hereby grant the permission necessary to allow Minor to participate in the Theatre Camp to be conducted by Selassie Amana and A+ Kids Theatre. I, in my own behalf and on behalf of Minor, further agree to release and to hold harmless Selassie Amana and A+ Kids Theatre as well as College Park Church venue on whose premises the Program will occur and it's employees and representatives, (hereinafter the “Releasees”) from any and all liability, whether caused by the negligence of the Releasees or otherwise for any claim, judgement, loss, liability, cost and expenses (including, without limitations, attorney’s fees and costs) arising out of or connected with the Program, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic, and/or death) that Minor may incur or sustain during the Program, all activities associated with the Program and while traveling to and from the site for the Program. I hereby warrant that I have read this Liability Release in its entirety and fully understand its contents. I have signed this document voluntarily and of my own free will.

Medical Release I, in my own behalf and on behalf of Minor, acknowledge and agree in the event of emergency illness or injury, I authorize Selassie Amana and A+ Kids Theatre to obtain necessary medical treatment of Minor and hereby, in my own behalf and on behalf of Minor, release and hold harmless Releasees in the exercises of this authority.

*In the event of a medical emergency, the parent/guardian and/or emergency contact will be called immediately.

Media Release I give permission for photos and/or video taken of my child to be used by A+ Kids Theatre for promotional purposes of A+ Kids Theatre.

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Liability Waiver-Summer Camp