Teen Truth Student Leadership Summit
Thank you for your interest in our Teen Truth Summit! It takes place on August 26th from 9AM-Noon and is open to middle school and high school students. Location is at Expressions Dance Theatre - 2434 High St., Crescent Springs, KY. Lunch will be provided. Please complete this form if you'd like your child to attend! We will contact you for payment ($85 plus sales tax), so please be sure to leave an email and phone number. Please complete only one form per child.
Email *
Parent First & Last Name *
Parent Contact Number *
Student First & Last Name *
Student Age & Grade *
PLEASE READ AND CHECK THAT YOU UNDERSTAND AND AGREE TO THE FOLLOWING CONDITIONS:

WAIVER OF LIABILITY STATEMENT AND PERMISSION TO TREAT

I, the parent or legal guardian of the student(s) listed above, hereby give approval of the student's participation in any and all Expressions Dance Theatre (EDT) and/or Expressions Children's Theater (ECT) programs and activities. I do waive, release, absolve, indemnify, and agree to hold harmless the organizers, sponsors, supervisors, participants, and persons involved in the operation of EDT/ECT programs for any claims arising out of injury or other loss to named student or any member of his/her family whether as a participant in the activities or as a spectator.

I will also authorize EDT and its owners, employees, directors, etc. to use standard first aid procedures on the above listed student(s) and consent to any other medical treatment necessary in case of an emergency.  Additionally, I certify that I personally and/or my medical insurance carrier will be responsible for all expenses which are incurred in relation to any injury sustained during any EDT/ECT related activity.
 *
A copy of your responses will be emailed to .
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