Medical/Photo Release and Behavior Contract

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2021-2022 Season
**Students without this contract will not be eligible to stay at classes, camps, rehearsals, workdays or productions until all forms are submitted.**

Email *

I give permission for my child *

Date Of Birth *

YYYY

To Participate in the following- (Please click all that may apply.) *

Winter 2021/22

Spring 2022

Other:

Required

Parent/Guardian Name * *

Address *

City, State *

Phone Number *

Emergency Contact Name and Number *

Insurance Company Name *

Insurance Company Policy or Member Number *

Medical Information (Allergies, Medications..etc) *

Adult in charge may give my child tylenol * *

Yes

I hereby authorize and consent that CYT shall have the absolute right, without any compensation to my child or me, to copyright, publish, use, sell or assign any and all photographs, portraits or pictures, television spots, movie films, videotapes and/or sound recordings, or any part thereof, that have been taken of my child, or in which my child may be included in whole or in part. * *

Yes

In the event of an accident or medical emergency, I give permission to the designated adult supervisor in charge to secure emergency medical treatment for the minor involved. I also agree to hold CYT, and/or their assignees, harmless in the event of an injury or accident. *

Yes

Required

Parent Signature- I understand that this is a legal representation of my signature. *

I know that participating in CYT is a privilege. I, *

Will *

Respect Coordinators, teachers, Artistic Team, parents, other students, and facility representatives at all times.

Use God honoring language & actions; I will not gossip, name-call, use profanity or inappropriate words or actions.

Dress modestly and appropriately.

I will avoid the use of drugs, alcohol, cigarettes, & overt physical contact with others.

Attend EVERY CYT class and Showcase unless given permission by the a Coordinator to be absent.

Stay onsite in CYT designated areas at all times. Treat property and equipment of the facility with care.

Required

I understand if I do not abide by the rules stated above, there will be consequences. Such as: *

Step 1: Adult in charge will talk with the individual student about his/her misbehavior

Step 2: Adult in charge will call the parent and explain the misbehavior of the student.

Step 3: Coordinator will be notified; one or both will talk with the student.

Step 4: Artistic Director will be notified, will talk with student (if warranted), and dismissal from the program may result.

Required

I read and understood the behavior requirements, and I know that any infractions will be documented and may affect future CYT participation. (Type Student Name) *

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