I give South Bend Civic Theater my permission to use photographic images, video, or audio recording of me gathered during my SBCT participation, for use now and in perpetuity, without compensation or further communication. By signing, I also consent that in the instance of a medical emergency and am unable speak for myself, I give SBCT staff permission to seek medical treatment on my behalf. I also agree to release SBCT from all liabilities in the case of injury to person and/or property. Please type your full name below. *