Release From Liability
I hereby give permission for My Child Camper Listed Above, to participate in the Sam Bass Theatre Youth Guild Workshop. I declare that I am the parent or legal guardian of the above named child, and I have custody and control of the child. In the event my child is injured or should require medical attention, I hereby request that you contact me or our
emergency contact. In the event that we cannot be reached, I hereby authorize the Sam Bass Theatre to secure necessary medical treatment for my child. I further acknowledge that I will be responsible for any medical or hospital fees or costs associated with my child’s medical treatment. I understand that as a participant, my child may be climbing on and off of stage and set pieces. I further understand that my child may be running, jumping, dancing and varied other movements on stage. I understand that my child may be running, jumping, dancing near moveable set pieces. I assume all risks and hazards to such participation including transportation to and from rehearsals and performances and hereby waive,
release, absolve and indemnify and agree to hold harmless, Sam Bass Theatre, it’s organizers, sponsors, supervisors,
and participants for any claim arising out of accidental injury to my child.
** A PAPER VERSION OF THIS FORM WILL BE REQUIRED TO BE SIGNED AT THE WORKSHOP BEFORE THE PARTICIPANT WILL BE PERMITTED TO ATTEND **
