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THIS EVENT HAS BEEN CANCELLED
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End Date/Time:
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Fee per Student:
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Room:
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Participant Waiver
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I represent that I am the participant, parent or legal guardian of the participant(s) named above, or I have obtained permission from the parent/legal guardian of the participant(s) named above to execute this agreement on their behalf. I agree that the participant(s) named above and I shall comply with all stated and customary terms, posted safety signs, rules and verbal instructions as conditions for participation in any part and/or program at MJPAA. In addition, if I observe any hazard during our participation, I will bring it to the attention of the nearest MJPAA employee or official immediately.
I've read the above and agree.
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Assumption of Risk
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In case of emergency or sudden illness, I hereby give permission for a staff member of Mary Jo's Performing Arts Academy to authorize any physician, nurse practitioner, medical personnel or hospital to render immediate emergency aid as it might be required for the undersigned student's health and safety. I hereby declare any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good physical and mental health. It is required that all students be covered by their own family insurance and if injury occurs, it is understood that the students own policy is the only source of reimbursement.
I've read the above and agree.
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Photo and Video Release
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I understand and acknowledge that, from time to time throughout the year; myself and my child may be photographed and/or videotaped while participating in functions involving MJPAA. I do hereby authorize Mary Jo's Performing Arts Academy to use these photographs and videotapes for the purposes of illustration, advertisement and publication in any manner whatsoever.
I've read the above and agree.
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Other Questions/Comments: |
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