Theatre South Waiver
Guardian's Full Name
*
First Name
Last Name
Date
*
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Month
-
Day
Year
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Student Name
*
First Name
Last Name
Name of Program
E-mail
*
Emergency Contact Number
*
-
Area Code
Phone Number
Allergies or Medical Conditions
*
Please check the box below to indicate that you have read and agree to the above:
*
I have read and agree to the above waiver, release, and indemnification agreement, consent to treat and photo release waiver.
Guardian's Signature
*
Submit
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