His Way Broadway Spring Registration

Additional Information
Adults allowed to pick up your children from class
Allergies or medical conditions of which HWB should be aware
Does your child carry an EpiPen?*
Child's T-shirt Size *Please list the name of each child before shirt size. IE- Johnny: Youth Medium**
Deposit Payment Method*

CashCheckPayPal (hiswaybroadway@gmail.com)Venmo (studiofivesixteen)Scholarship application pending

Recording and Usage Consent and Release
I consent and authorize His Way Broadway to do any or all of the following in respect of my child: • Film record, photograph or otherwise capture the following featuring my child at, or as part of, the His Way Broadway: still images (including photographs); moving images (including film/video)and/or audio recordings (in each case, a “Recording”). • Use any or all Recordings at any time in the future (and for any duration) for the following purposes: fundraising, advertising, promoting or marketing His Way Broadway (together the “Permitted Purposes”). Confirming ownership of Recordings . We also need to ensure that we own the rights resulting images, audio, video or other recordings so that we can freely edit, copy, use and publish them without needing to contact you again. We will only use the images, audio, video or other recordings for the “Permitted Purposes” set out above.*

I consent.I do not consent. (Please contact our administrators)
Signature*

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Waiver and Release of Liability

All students must have this form on file to participate in a His Way Broadway Activity.
The undersigned voluntarily makes and grants this Waiver and Assumption of Risk in favor of His Way Broadway regarding the use of facilities, equipment,
materials, and/or other assets of said parties. I do hereby waive and release any and all claims whether in contract or of personal or bodily injury, loss of life, properly damage, or loss of property that may arise from my aforementioned use of facilities and/or participation in classes and activities. I accept and assume all risk on my behalf and that of my minor child. I further agree to use my best judgment in undertaking these activities to faithfully adhere to all safety instructions, recommendations, whether oral or written. I hereby certify that I am a competent
adult assuming these risks of my own free will, being under no compulsion or duress, and released said parties.
Signature*

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Date*

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His Way Broadway 5-12 Student Registration