CYT Medical Release

2020-2021 CYT KC Medical/Photo Release & Conduct Agreement

***Students without this contract will not be eligible to stay at classes, camps, rehearsals, or productions until all forms are submitted.***
I give permission for my child, *

First Name Last Name
To participate in CYT Kansas City's 2020-2021 activities (August 1, 2020 through July 31, 2021) *

Yes
Parent/Guardian Name *

First Name Last Name
Cell Phone Number: *

Area Code Phone Number
Primary E-mail *
Emergency Contact: *

First Name Last Name
Emergency Contact Phone: *

Area Code Phone Number
Insurance Company Name: *
Policy # or Member #: *
Primary Care Physician: *
Physician Phone: *
Allergies:
Medical/Behavioral Conditions:
Special Needs:
Medical Release

The undersigned, the parent or legal guardian of the above-named minor, grants permission of the above-named minor to participate in classes, camps and other activities provided or sponsored by CYT Kansas City, Inc. ("the CYT activities). The undersigned understands and acknowledges that the above-named minor may suffer injury, sickness or other physical harm from participating in such activities. The undersigned further understands that the undersigned is responsible for all costs and charges for medical treatment that may result from such injury or sickness, or other damages that otherwise result, relate to or arise from participation in the CYT activities.

The undersigned further understands and acknowledges that CYT Kansas City, Inc. will not allow the undersigned or the above-named minor or immediate relatives thereof to participate in the CYT activities without releasing and holding CYT Kansas City, Inc. harmless. The undersigned requests that CYT Kansas City, Inc. allow above-named minor to participate in the CYT activities, and in consideration thereof, agrees to release CYT Kansas City, Inc. from all actions, causes of action or claims for damage of any kind growing out of or relating to any of the CYT activities in which the undersigned or above-named minor or their immediate families participate. The undersigned acknowledges that this is a full and complete release of all injuries, sicknesses and damages that the undersigned or above-named minor or their immediate families may sustain or incur as a result of participation in the CYT activities.
Yes, *

I have read and understand the Medical Release.
Photo Release

The undersigned gives permission to CYT to use any and all photographic portraits or pictures, television spots, movie films, video tapes, websites and/or sound recordings, or any part thereof, taken or created during the CYT activities (which may include the undersigned and/or above-named minor and/or their immediate families) in promotional materials.
Yes, *

I have read and understand the Photo Release.

2020-2021 CYT KC Medical/Photo Release & Conduct Agreement

CYT Kansas City Code of Conduct