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Let's Learn, Play & Create Together

Child's Birthday
Month
Day
Year
Program/Class/Event Registering For

Playhouse Seat Options

We want children to have access to quality arts experiences regardless of financial circumstances. Please select the option that works best for your family.
If you selected a need for a sponsored playhouse seat, please indicate what you are able to contribute toward your child’s experience?
Does your child have any allergies, medical concerns, sensory needs, accessibility needs, communication needs, or other information we should know to help support their safe participation? *

Acknowledgments and Assumption

I understand that participation in Playhouse programs and activities involves inherent risks that cannot be completely eliminated, even with reasonable safety precautions. Risks may include slips, trips, falls, collisions, physical exertion, contact with other participants, equipment or materials, reactions or exposure to activity materials, and other injuries associated with play, movement, creative, educational and group activities. I voluntarily permit my child to participate and knowingly assume the risks reasonably associated with participation.

Health and Participation

I represent that, to the best of my knowledge, my child is able to participate safely in the activities for which they are registered. I agree to disclose any allergies, medical concerns, physical limitations, sensory or accessibility needs, or other information reasonably necessary for my child’s safe participation. I understand that Playhouse staff and instructors are not medical providers and that The Playhouse cannot guarantee an environment completely free from allergens, illness, injury or other risks.

Emergency Medical Authorization

In an emergency, I authorize The Playhouse, ACT 4 Life, Inc., and their authorized staff or representatives to contact emergency medical services and take reasonable action necessary to protect my child’s health and safety. If I cannot immediately be reached, I authorize emergency medical personnel to evaluate and provide reasonably necessary emergency care. I understand that I am responsible for resulting medical, ambulance or hospital expenses unless otherwise required by law.

Waiver and Release of Liability

In consideration of my child being permitted to participate, I voluntarily assume the risks associated with Playhouse activities. To the fullest extent permitted by law, I release and hold harmless ACT 4 Life, Inc., The Playhouse, and their officers, directors, employees, instructors, teaching artists, contractors, volunteers, representatives and agents from claims arising from the ordinary and inherent risks of participation. Nothing in this agreement waives any right or claim that cannot lawfully be waived.

Parent Guardian Responsibility

I understand that certain Playhouse activities may require a parent or guardian to remain on-site. I agree to follow Playhouse safety rules, illness policies, check-in/check-out procedures and reasonable staff instructions. I understand that The Playhouse may restrict or discontinue participation when reasonably necessary to protect the health, safety or well-being of my child, other participants, staff or visitors.

Photography & Video Recording

I understand that photography, video and/or audio recording may occur during Playhouse activities. As a condition of participation, I authorize The Playhouse, ACT 4 Life, Inc. and their authorized representatives to photograph or record my child as permitted by my media selection below and to use authorized media in connection with their programs, mission, promotion and activities in any lawful media or format, whether now known or later developed.

Media Use and Release

I understand that authorized media may be edited, cropped, reproduced, published, displayed or distributed without further notice or approval from me. I understand that I will receive no compensation or royalties and waive the right to inspect or approve finished materials. I understand that publicly shared media may be copied or redistributed by others and that The Playhouse and ACT 4 Life, Inc. cannot control subsequent third-party use or distribution.


Media Consent- Select One

Electronic Acknowledgement By checking the box below and entering my full legal name, I certify that I am the child’s parent or legal guardian and have authority to enter into this agreement. I acknowledge that I have read and understand the Parent/Guardian Waiver, Release & Media Agreement, including the assumption of risk, liability release, emergency authorization, parent responsibilities and media provisions, and voluntarily agree to its terms.

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