HTSI 2023 at The Dream Center REGISTRATION FORM

HTSI 2023 Creative Arts Program @ TDC Application

Harlem Teen Shakespeare Intensive Summer Program
YOUTH Participant Name*

First NameLast Name
Age of YOUTH Participant as of 7/10/2023*
YOUTH Participant Birth Date*
YOUTH Participant Gender
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*

Area CodePhone Number
Emergency Contact (if Parent/Guardian can't be reached)*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Relationship to the YOUTH Participant*
Information Release

Please read the following and sign if you agree to ALL statements
LIABILITY RELEASE

I give permission for my child to participate in Harlem Teen Shakespeare Intensive at The Dream Center. I understand that participation in these activities requires participants to abide by applicable rules and standards of conduct. I hereby release The Dream Center staff and volunteers and Classical Theatre of Harlem (administrators of HTSI) from responsibility and liability for any illness or injury that my child may sustain during this program. In the event of an emergency, I hereby authorize an adult leader of this activity as an agent for me, to consent to medical attention from a medical professional either at a doctor’s office or in a hospital. I expect to be contacted as soon as possible.

MEDIA RELEASE

I also give The Dream Center permission to publish in print, electronic or video format the likeness or image of my child and/or audio recording of my child. I release all claims against The Dream Center and Classical Theatre of Harlem (administrators of HTSI) with respect to copyright ownership and publication including any claim for compensation related to the use of materials. Images, video or audio recordings of my child taken or recorded by The Dream Center and Classical Theatre of Harlem can be used in print, broadcasting or other forms of marketing and advertising: brochures, newsletters, reports, online (website, Twitter, Facebook, Instagram, YouTube). These photos, videos or other images of recordings may be used by The Dream Center without payment of fees, royalties or other remuneration.

PERMISSION TO TRAVEL OFF-PREMISES

I give permission for my child to attend/participate in a meet and greet with the actors in The Classical Theatre of Harlem at the Richard Rodgers Amphitheater in Marcus Garvey Park [18 Mount Morris Park, NYC] on a date to be determinded. (The date will be on the final summer schedule). HTSI participants will walk together, accompanied by the teaching artists, to Marcus Garvey Park and then return to The Dream Center, after the meeting. The visit will take place during the program day.

I also give permission for my child to leave the premises of The Dream Center accompanied by the teaching artists to film in the surrounding neighborhood.

I give permission for my child to attend/participate in The Green Show at the
Richard Rodgers Amphitheater in Marcus Garvey Park [18 Mount Morris Park, NYC] with Harlem Teen Shakespeare Intensive (HTSI) at The Dream Center on Saturday, July 29, 2023. The Green Show will be a performance featuring the HTSI students on the stage at the Richard Rodgers Amphitheater prior to The Classical Theatre of Harlem’s performance. HTSI participants will walk together, accompanied by the teaching artists, from The Dream Center to Marcus Garvey Park. They will be dismissed from the park after their performance.

I hereby release The Classical Theatre of Harlem and The Dream Center staff and volunteers from responsibility and liability for any illness or injury that my child may sustain during these activities. In the event of an emergency, I hereby authorize an adult leader of this activity as an agent for me, to consent to medical attention from a medical professional either at a doctor’s office or in a hospital. I expect to be contacted as soon as possible.
Participant Signature*

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Parent Signature*

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HTSI 2023 Creative Arts Program @ TDC Application

Information Release