2024-2025 Hold Harmless and Releases

The Belle Theatre
The Belle 2024-2025 Hold Harmless & Photo Releases

Valid June 3, 2024 - June 1, 2025
My signature below states the following:
• I give my child permission to participate fully at The Belle Theatre, Inc. I recognize this includes, but is not limited to, certain physical activities, which may pose some risk of injury. I further understand and agree that The Belle Theatre, Inc. is not an insurer nor is responsible for any costs incurred by me or my child arising from activities conducted within the scope of this program.

• I indemnify and hold harmless the The Belle Theatre, Inc., any of its employees, officers, board members, sponsors, partner organizations, contractors, and/or agents from all claims from my use of The Belle Theatre property or participation in any programs. I will further indemnify and hold harmless The Belle Theatre, Inc., its employees, officers, board members, sponsors, partner organizations, contractors, and/or agents, and other associated parties from all costs, expenses and liabilities resulting from any claim brought from my child(ren)’s use of The Belle Theatre’s property and/or participation in The Belle Theatre programs to the extent of The Belle Theatre’s liability under general law.

• The emergency contacts listed are authorized to make emergency decisions on my behalf if I cannot be reached. In the event that no one can be reached, I authorize The Belle Theatre, Inc. to arrange any necessary emergency medical treatment.

• In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for: (1) the administration of any treatment deemed necessary by the appropriate medical professional; and (2) the transfer of the child to any hospital reasonably accessible.

• I understand that ONLY persons on the “Authorized Person(s)” list will be allowed to pick up my child and that they and I will be required to present photo identification each day before my child is released.

• I understand that photographs and videos may be taken of my child during the course of this camp and I give The Belle Theatre, Inc. permission to use these photographs and videos for publicity purposes. I hereby release and hold harmless said companies from any reasonable expectation of privacy or confidentiality associated with the images and/or videos specified. All images and/or videos will be stored on company devices and profiles.

• I have read and fully understand the above information, warning of risk, and assumption of risk and waiver and release of all claims. I have had the opportunity to ask questions and am voluntarily signing below without any inducement.
Students Full Name*

First NameLast Name
Parents Full Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Clear

PHOTO RELEASE / PERMISSION TO USE PICTURE FOR PROMOTIONAL PURPOSES
The undersigned parent or legal guardian of {studentsFull} (“Child”), hereby grants to The Belle Theatre the right to photograph said, Child, and to use said photographs, regardless of the form thereof, which may include but not necessarily be limited to still format, digital format or still or digital format video, to promote The Belle Theatre. It is understood and agreed that the photographic images taken by The Belle Theatre and used by them for promotional purposes may be used in various forms, including but not necessarily limited to, printed forms, transmission via internet, television or otherwise. The permission herein granted shall continue in effect unless revoked in writing.
Date Signed*

MonthDayYear
Signature*

Clear

MEDICAL RELEASE & EMERGENCY CONTACT FORM
Students Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Male / Female*
Parents Name 1*

First NameLast Name
Parent 1 Number*
Please enter a valid phone number.
Parents Name 2

First NameLast Name
Parent 2 Number
Please enter a valid phone number.
Student Physician and Phone #*
Student Known Medical Conditions: (If None write N/A)*
On-Site Medication

Please indicate if your child will need medication on site (epipen, inhaler, prescription medication). All medications are stored by staff locked in our office.
List medication below:
Administered by Staff
If yes, I will meet with Staff for instruction.

Clear
Other Conditions including Learning Disabilities, Mental Health Concerns, IEPs or 504s we should be aware of? (this is completely voluntary and not mandatory to be disclosed)

EMERGENCY CONTACT INFO
ER Contact 1 Full Name*
ER Contact 1 Phone Number*
Please enter a valid phone number.
ER Contact 2 Full Name
ER Contact 2 Phone Number
Please enter a valid phone number.
ER Contact 3 Full Name
ER Contact 3 Phone Number
Please enter a valid phone number.
The above contacts are authorized Emergency Contacts.*

Clear
PICK-UP PERMISSION FORM

The following people have my permission to pick up my child from The Belle Theatre:
Pick-up 1 - Name, Relation, Phone Number*
Pick-up 2 - Name, Relation, Phone Number
Pick-up 3 - Name, Relation, Phone Number
Pick-up 4 - Name, Relation, Phone Number
Pick-up 5 - Name, Relation, Phone Number
I understand my student MUST be signed out by an authorized person listed above. They must physically be present and enter the building to sign-out the student.*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

The Belle Theatre

The Belle 2024-2025 Hold Harmless & Photo Releases

My signature below states the following:

PHOTO RELEASE / PERMISSION TO USE PICTURE FOR PROMOTIONAL PURPOSES

MEDICAL RELEASE & EMERGENCY CONTACT FORM

On-Site Medication

EMERGENCY CONTACT INFO

PICK-UP PERMISSION FORM