After School Improv Club Sign Up

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How did you hear about our after-school program?
Former camp attendee
A friend
Social Media
Centre Region Parks & Rec Guide
Newsletter
Other
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First, we need the name of participant in the club.* This field is required.
First Name
Last Name
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What grade is the participant in?* This field is required.
5th
6th
7th
8th
9th
10th
11th
12th
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Next, we need a parent or guardian.* This field is required.
First Name
Last Name
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How about an email address for the parent or guardian?* This field is required.
example@example.com
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We'd also like a phone number on file for the parent or guardian to contact in case of an emergency.* This field is required.
Area Code
Phone Number
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Optional: Email of the students taking part in the camp so we can copy them into informational emails.
example@example.com
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Add to your cart. Choose either 1 month or 3 months. You'll enter credit card information on the next screen. * This field is required.
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ORDER SUMMARY
Total costUSD
One-Month of Improv ClubThe cost for each month of the improv club is $100. There is a slight discount when signing up for 3 months.
$100.00Edit
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Three-Months of Improv ClubThe cost for each month of the improv club is $100. There is a slight discount when signing up for 3 months.
$275.00Edit
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Total cost $0.00
Credit Card
First Name
Last Name
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Please select which months you are signing up for.* This field is required.
February
March
April
May
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Is there anything you’d like us to know about your student? (Health concerns, goals they have for participation, etc.)
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Normal
Small
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Ok
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Signature for Limitation and Release of Liability of HVI and Consent for Taking and Sharing Photographs * This field is required. By signing and submitting this form, I, the undersigned, [a parent or legal guardian of] the participating individual (the “Participant”), hereby agree to the following participation waiver and limitation and release of liability to Happy Valley Improv LLC (the “Company”): Participation in any and all physical activities can be inherently dangerous and, regardless of due care taken to avoid injury, it is impossible to guarantee the safety of all Participants. Theatre activity is no exception to the hazards attenuated to other physical activities. Improv is an activity that demands cardiovascular fitness, coordination, and agility. I, the undersigned, certify that Participant possesses a sufficient degree of physical fitness to safely engage in theatre activity, will indicate below any health-related conditions that might affect Participant’s ability to engage in improv activity, will immediately and verbally inform the instructor(s) if Participant feels undue discomfort or stress, and will immediately discontinue activity should illness or injury occur. In the event of a medical emergency, the Company will call Emergency Medical Services to render aid and I, the undersigned, will be financially responsible for any and all expenses incurred. To reduce the risk of injury, Participant is expected to abide by the rules set forth by the Company and the instructor(s). Participant shall follow all safety rules, written, posted, or otherwise stated. Participant will constantly remain aware of his or her surroundings and diligently avoid risk as possible. Participant is voluntarily registering and engaging in theatre activity and, in doing so, assuming all inherent risk of the physical activity involved. In consideration of permission to engage in activity, I, the undersigned, on behalf of myself, my family, heirs, and assigns, hereby release the Company or its agents, employees, independent contractors, and assigns from liability for injury, loss, or death to Participant while using any facility or equipment, during theatre activity or while on the premises, or in any way associated with the Company, now and in the future, resulting from the ordinary negligence of the Company or its agents, employees, independent contractors, and assigns. Further, I, the undersigned, hereby consent and agree that the Company shall have the right to take photographs of Participant for use on the Company’s website and promotional materials. Compensation for any photographs will not be provided. Participant’s name and identity will not be revealed; the use of the Participant in promotional photography can be stopped at any time upon written request via email. In accordance with the Pennsylvania Electronic Transactions Act, this agreement will be binding upon all of the parties when counterpart copies are electronically signed by all of the parties, by inserting a typed or printed name in the space provided.
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