Summer Camp Registration

Parent/Guardian Information

Emergency Information

Authorized Pick Up 

Please list whom is allowed to pick up your child from camp

Informed Consent and Acknowledgement

I (we) release and forever discharge Altadena Music Theatre, its Board of Directors,
employees, staff, and volunteers, from any and all liability for any injury, damage,
loss, cost or expense (including, without limitation, reasonable attorney’s fees) of
any nature that volunteer or student may at any time have or incur, arising out of or
in any manner related to any loss, damage, or injury, including but not limited to
suffering and death, or any personal property damage or loss belonging to
volunteer/student and affiliates that may occur while participating in said events.
By signing this agreement, I acknowledge that participating in group activities in
relation to dance and play can sometimes lead to injury. Cast members and
Parental guardians must agree to rehearse and perform at your own, or your child's
risk for respiratory infection, flu, cold, and covid 19, et al.
I voluntarily agree to assume all of the forgoing risks and accept sole responsibility
for any injury to my child(ren) or myself (including but not limited to, personal injury,
disability and death), illness, damage, loss, claim, liability, or expense of any kind
that I or my child(ren) may experience or incur in connection with my child(ren)'s
attendance at Altadena Music Theatre or participation in Altadena Music Theatre
programming. On my behalf, and on behalf of my children, I hereby release
covenant not to sue, discharge, and hold harmless Altadena Music Theatre, its
employees, agents, and representatives of and from the claims, including all
liabilities, claims, actions, damages, costs or expenses of any kind arising out of or
relating thereto. I understand and agree that this release any claims based on the
actions, omissions, or negligence of Altadena Music Theatre, its employees, agents,
and representatives.

Medical Release and Authorization

As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Altadena Music Theatre and its affiliates including Directors and coaches to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered session.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Photo/Video Release

I give my consent to Altadena Music Theatre to photograph, film, videotape and
then use, reproduce, and publish those images of me and/or my child/children.

I agree the photographs/negatives, film, or videotapes shall constitute the sole
property of Altadena Music Theatre , with full right of disposition, including the right
to publish on its website, promotional video, social media pages, and brochures.
I release Altadena Music Theatre and its legal representatives from any and all
claims in connection with the use, reproduction, publication of the images.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.