Innovation Drama Academy TERM 1 REGISTRATION

My Living Studio Class Registration Form

Registration and Consent
Parent/Guardian Name: If Applicable

First NameLast Name
Parent/Guardian Phone Number

Area CodePhone Number
Parent/Guardian Email:
example@example.com
Student Name

First NameLast Name
Which Class Are You Registering For?
Student's Age At Time Of Registration
Student's Email
Student's Phone Number
Home Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Emergency Contact Name

First NameLast Name
Emergency Contact Number

Area CodePhone Number
Film/Stills Consent

Consent for Film Recording and Still Use. I hereby grant My Living Studio permission for my image, voice, and/or work to be recorded and used in educational outreach materials, including videos, photographs, and written publications.

I understand that these materials may be used for educational, promotional, or informational purposes and may be distributed via print, online, or other media.

I acknowledge that participation is voluntary and that I will not receive compensation. I have read and understood the information above.
Have you read the waiver above and understand all its terms and conditions?
Actra Union Status?
Actra Union Number: If Applicable
Name of Parent/Guardian that agrees and adhere to image consent

First NameLast Name

Health History

Rows	No	Yes	Please Explain.
Does the student have any restrictions on activity?
Will the student need any special assistance while in class?
Is there there anything else you feel we should know health wise about the student? Please list any other medical information the instructors should have regarding the student.

Medical Questions

Rows	No	Yes	If yes, please explain.
Does the student have any allergies?
Does the student require an EpiPen?

My Living Studio Class Registration Form