PACE IMPROOV Workshop Series

Student Information

Student First Name *

Student Last Name *

Parent First Name *

Parent Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Student Age *

Emergency Contact Info

First Name *

Last Name *

Phone Number *

Relation to Child *

First Name

Last Name

Phone Number

Relation to Child

Preferred Hospital

Insurance Company

Insurance Policy #

Insurance Phone Number

Medical Information (Please list any medical infomration that the instructor/director should be aware of: allergies, medications, medical conditions, etc.)

Photo Release

I hereby grant PACE Youth Theatre permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of PACE Youth Theatre and will not be returned. I hereby irrevocably authorize PACE Youth Theatre to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge PACE Youth Theatre from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT: *

I grant PACE my permission to use the photographs of my child.

I DO NOT grant PACE my permission to use the photographs of my child.

*

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Waiver and Release of Liability

In consideration of the risk of injury while participating in a 2020 PACE Youth Theatre (PACE) class and production (the “Activity”), and as consideration for the right to participate in the Activity, I, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation or the participation of any minor specifically identified below in the Activity, and do hereby release and forever discharge PACE Youth Theatre, their affiliates, managers, members, agents, attorneys, staff, volunteers, representatives, predecessors, successors, and assigns for any physical or psychological injury including, but not limited to illness, paralysis, death, damages, economical or emotional loss that I or any minor children specifically identified below may suffer as a direct result of participation in the Activity, including traveling to or from an event related to this Activity.

I AM PARTICIPATING IN THE ACTIVITY AND I AM PARTICIPATING THE ACTIVITY ENTIRELY AT MY OWN RISK AS TO MYSELF AND TO ANY MINOR CHILD SPECIFICALLY IDENTIFIED BELOW. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM THE ACTIVITY AND THE ACTIVITY ITSELF, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN NEGLIGENCE, THE NEGLIGENCE OF THE MINOR CHILD OR CHILDREN SPECIFICALLY IDENTIFIED BELOW, THE NEGLIGENCE OF OTHERS, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO ME, OF MY PARTICIPATION OR THE PARTICIPATION OF THE MINOR CHILD OR CHILDREN SPECIFICALLY IDENTIFIED BELOW, INCLUDING TRAVEL TO AND FROM AND PARTICIPATION IN THE ACTIVITY.

Having carefully read this Waiver and Release and fully understand it is a release of liability, I give permission for my child(ren) listed below to participate in the 2020 PACE Youth Theatre (PACE) classes and productions. I give permission to the designated adult supervisor in charge to secure emergency medical treatment for my child(ren) under the same terms of liability waiver otherwise found in this document. *

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Student's Date of Birth * +

Student's Full Name *

COST

Below are the classes we offer. You may select multiple classes.

PACE IMPROOV Workshop Series-$100.00

Scholarship Donations

Every semester PACE offers scholarships to families in need. If you are able to donate, we would greatly appreciate it.

PACE works to make our classes available to all families in our community. If you are able, please consider donating to students in need of a scholarships.

Total Amount Due

If you have more than one child taking classes, select the Multi-child 5% discount below.

Multi-child 5% discount

If your child is taking more than one class, select the Multi-class 5% discount below.

Multi-class 5% discount

Calculate Total with all discounts and donations included.

$0.00

Please continue to review your registration and pay using PayPal