STEP 1. Contact Information
(printable medical form available
HERE
)
Parent's Name
Physician's Name:
Child's Name:
Address:
Address:
Phone:
Email:
Phone:
In which session(s) is your child enrolled? 1
2
3
4
5
6
7
STEP 2. Medical History
Medical Concerns (include allergies, medications*, etc.):
Date of Last Tetanus Shot:
*Please note that Adventure Theatre staff can not administer any medication. If you have special medical concerns, please contact us as soon as possible.
STEP 4. Liability Release
Adventure Theatre assumes no liability for injury or damages arising from the result of participation in its classes, workshops or programs unless due to gross negligence or willful fault on the part of Adventure Theatre. I hereby approve my child's participation in this activity and consent to emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions that may interfere with my child's participation.
Accept:
Decline:
STEP 5. Car Pool Information
A list of those wishing to car pool will be available in the Theatre office and available by email at least one week before the start of each Session.
You have my permission to put my name, address, phone number, and email on the car pool list.
Yes
No
