Student & Family Information
Grade in School
Full Name of Parents
Primary Phone Number
Alternate Phone Number
Home Street Address
Home Phone #
Cell Phone #
Medical Contact Info
Health Concerns/Allergies - Please Identify Here
Please consider the following medical conditions when listing health issues: Heart Condition or Disease, Asthma, Diabetes, Seizure Disorder, Allergy Medication, Allergy to Insect stings, FOOD ALLERGIES. If the student has these or other serious health considerations, list any current medications, and detailing any special restrictions or limitations, or treatment that should be followed. We will only use this information in case of an emergency. If there is an emergency student will be transported to the nearest emergency room.
I HAVE VOLUNTARILY PROVIDED THE ABOVE CONTACT INFORMATION AND AUTHORIZE THE PERFORMERS SCHOOL TO CONTACT ANY OF THE ABOVE EMERGENCY CONTACTS ON MY CHILDS BEHALF IN CASE OF EMERGENCY. * PLEASE SIGN AND DATE YOU COMPLY WITH THIS.
THE PERFORMER’S SCHOOL, INC (“TPS INC”) MINOR RELEASE and RELEASE of LIABILITY WAIVER
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Please read carefully and sign the waiver form. Participation is not allowed until the waiver is signed. I, (we) despite all reasonable precautions implemented for safety, am (are) fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses associated with participation in the programs or activities. I (we) knowingly and willingly assume all such risks on behalf of the minor. Consequently, I (we) hereby for myself, heirs, trustees, executors and administrators, do waive and release any and all rights and claims for damages against the owners, operators, employees, independent contractors, coaches and members of TPS, Inc from personal injury or accident of any sort or nature suffered by the minor, the undersigned, by reason of participation or membership in classes, lessons and/or any programs or activities of TPS, Inc. I, the minor’s parent and/or legal guardian, understand the nature of these activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity. I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the release from all liability claims, demands, losses, or damages on the minor’s account caused or alleged to be caused, in whole or in part. I further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the releases named above, I will indemnify, save, and hold harmless each of the releases from any litigation expenses, costs, expert witness fees, attorney fees, loss liability, damage, or cost that may incur as the result of any such claim. I/WE HAVE READ THE FOREGOING AND UNDERSTAND THAT ITS TERMS INCLUDE MY/OUR CONSENT AND MY/OUR AGREEMENT TO TAKE CERTAIN ACTIONS, TO ASSUME CERTAIN RESPONSIBILITIES AND TO RELEASE TPS, Inc FROM CERTAIN LIABILITIES. I/WE SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.
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Mon. June 12 – Animals can talk
Tues. June 13- Fairytales
Wed. June 14 – Friends & Favorite things
Thurs. June 15 – Beach Day
Friday June 16 – Living a Bugs Life
All 5 Days
Should be Empty: