General Permissions, Code Of Conduct, And Medical Forms printable pdf download

General Permissions, Code Of Conduct, And Medical Forms

651‐426‐3275 Business Office

Lakeshore Players, Inc.

651‐429‐5674 Box Office

Creating Community Theatre Since 1953

office@lakeshoreplayers.com

4820 Stewart Avenue • White Bear Lake, MN 55110

PERMISSION FORM

Lakeshore Players Theatre (LPT) must have a signed Permission Form, Code of Conduct Agreement,

and Medical Information form on file FOR EACH PARTICIPANT in order for students to participate in

Summer Youth Programs. By signing the forms you acknowledge that you read, understand, and agree

to each of the following provisions.

GENERAL PERMISSION: I give permission for my child to participate in this Lakeshore Players

Theatre Outreach & Education Program.

LIABILITY WAIVER: I understand Lakeshore Players Theatre (LPT) and all of its associates are not

liable for any loss, damage, or injury to any property or person attending camp. If all efforts to contact

the emergency contact person(s) are unsuccessful, in case of emergency, I hereby give the LPT staff

permission to seek medical attention for the participant. LPT staff may also administer medication

prescribed for the camper.

INJURY and INSURANCE WAIVER: I understand that parents assume full responsibility for any

bodily injury incurred by their child while taking part in Lakeshore Players’ programs, and that no

accident insurance is provided through Lakeshore Players, Inc.

IMAGE RELEASE: Photos and/or video of my child may be used for promotional purposes in print, on

websites and social media.

Participant Name (Please Print Legibly) _________________________________________

Parent /Guardian Signature:________________________________________________

Date:____________________________

Camper T-Shirt Size

(Please check one box)

 Youth Small

 Youth Medium

 Youth Large

 Adult Small

 Adult Medium

 Adult Large

 Adult X-Large

General Permissions, Code Of Conduct, And Medical Forms