Alice in Neverland 2022 ************** Actor Permission Form

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I give permission for my child to participate in the February 2022 Lexington School play. *

Yes

First and Last Name of Actor *

Grade *

Name of Parent or Guardian *

Home Phone

Parent Cell phones *

Parent emails *

I have completed my Participation Fee payment of $100 to https://www.lexhsc.org/schoolplay (Scholarships are available; contact Mr. Deppong) *

Yes

I agree to volunteer 5 hours of adult time working on the production or performances. *

Yes

No (see below)

Required

I agree that if I cannot volunteer 5 hours of adult time on the production, that I will pay the Buy-Out Fee of $200 to help hire workers to replace me. *

Yes

N/A

Required

I hereby release the Los Gatos Union School District to use any and all pictures and video of my child taken in regards to the February 2022 Lexington School Play. I understand that such photographs and video will ONLY be used for Los Gatos Union Elementary School District publications or exhibits. *

Yes

Lexington School Play Essential Agreements for Student Behavior - I understand that during rehearsals and the play, I am responsible for following all of the school rules for behavior. *

Yes

Lexington School Play Essential Agreements for Student Behavior - I will follow all of the attributes of the IB learner profile. *

Yes

Lexington School Play Essential Agreements for Student Behavior - I understand that being in the school play is a privilege and that I might not be able to participate if I do not follow these agreements. *

Yes

Lexington School Play Essential Agreements for Student Behavior - I will listen respectfully to all supervisors and follow directions. *

Yes

All technical equipment, costumes, and props for the play which are given to the actors for use for the production will be treated with respect - as school property, only used during rehearsals and performance, and will be returned in the same condition as received, as much as possible. *

I agree

I disagree

Dress or Shirt Size *

Pants Size *

Shoe Size *

LOS GATOS UNION SCHOOL DISTRICT 17010 Roberts Road , Los Gatos, CA 95032 WAIVER, RELEASE AND INDEMNITY AGREEMENT, ASSUMPTION OF RISK FOR PARTICIPATION  IN VOLUNTARY NON-DISTRICT SPONSORED ACTIVITY Description of Activity: Lexington School Play; Date(s) of Activity: 1/3/2022 – 2/18/2022; By my signature below, I hereby agree to participate in the above-described activity. I realize that this activity is voluntary and is not part of the Los Gatos Union (District) program. The undersigned hereby acknowledges that he/she knowingly and voluntarily assumes all risks of bodily injury and expressly acknowledges their intention, by executing this instrument, to exempt and relieve the District, its officers, agents, and employees, from any liability for personal injury, bodily injury, property damage or wrongful death that may arise out of or in any way be connected with the above described activity. As a condition of my participation in this activity, I agree to waive all claims against the Los Gatos Union (District) and to indemnify and hold the District, its officers, agents, and employees, harmless from any and all liability or claims, demands, losses, causes of action, suits or judgments of any kind whatsoever that I, my heirs, executors, administrators or assignees may have against the District or that any other person or entity may have against the District because of any death, bodily injury, personal injury, or illness, or because of any loss to property that may arise out of or in any way be connected with the above described activity. The undersigned fully acknowledges that no District employees or designated volunteers will be participating in their capacity as District employees or designated volunteers, and that the District assumes no responsibility for any transportation arrangements. I further acknowledge that there is no District insurance coverage provided of any type, including but not limited to, workers’ compensation, liability, collision, comprehensive or medical coverage in connection with the above described activity. I have read the foregoing and have voluntarily signed this agreement. I am aware of the potential risks involved in this activity and I am fully aware of the legal consequences of signing this instrument. Please sign below with Adult Volunteer Signature, Street Address, City, State, Zip Code, Telephone Number, and email Address *

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