BRUKA CAMP FORM 2024 (INFORMATION)
Pertinant Information For Our Staff To Care For These Beautiful Humans
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Email *
Participants Age *
What name does participant go by? *
Theatre/Performance/Creation Experience *
Special Skills - Language, Music, Juggling ... Surprise Us!
Legal Name of Participant/Nickname or Name they would like to be called. *
Name of Parent/Guardian that filling out this form *
Parent/Guardians Name and Cell Numbers *
Will the participant be missing or late any of the days?   *
Does your child have permission to go home or get dropped off by anyone else?  (Name/Phone) *
Does the participant have any allergies or special instructions?   *
I, _______________________________________________________ hereby authorize Bruka Theatre to use, reproduce, and/or publish photographs or video that may pertain to me - including my image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, Public Service Announcements and on our web page. This authorization is continuous and remains in place unless specific notification is given. Waiver and Release. I hereby release and forever discharge and hold harmless Bruka Theatre and its officers and directors, employees, volunteer consultants and project leaders, its other types of volunteers, its nonprofit partner organizations, community partners, other member agencies, funders, and agents (Releasees), from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from my participation with Bruka Theatre.I understand that it is my responsibility to carry and maintain my own health and liability insurance. I understand and agree that this Release discharges Bruka Theatre (and the above mentioned) from any liability or claim, or demands or cause of action asserted by or on my behalf, that I may have with respect to any bodily injury, personal injury, illness, death, or property damage that may result from my volunteer service and/or participation whether caused by the negligence of Bruka Theatre or otherwise. I also understand and agree that, except as otherwise agreed to by Bruka Theatre in writing, Bruka Theatre does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury or illness.Release of Liability for Minors. I, the undersigned parent or guardian of a minor participating with me, attests that I am over 18 years of age and warrant that I have legal authority to execute the above agreement on my child or legal ward’s behalf. I have read the foregoing Waiver and Release of Liability and I hereby give my express consent to the irrevocable execution of this release on my child/legal ward’s behalf. *
A copy of your responses will be emailed to the address you provided.
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