Rock Da' Mic Heal Da' Hood Registration
THIS REGISTRATION FORM IS FOR ROCK DA MIC AND HEAL DA HOOD PARTICIPATION. All Denver youth are welcome, but must register. Parents and legal guardians may complete this form for youth. Heal Da Hood Dates are every Thursday 6:30 at 2840 Fairfax St. Denver, CO. 80207. Performance camp is every Friday TBD. Spaces limited. One registration per act. Youth can participate in no more than two acts per performance. Rock Da Mic dates are July 30th, August 27th, October 29th, and the finale December 30th to take place at Cleo Parker Robinson Theater. Each member in group must register individually for liability purposes. 
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Act Name *
Group Name

Your Full Name *
Your Phone Number *
Your Address *
Your Email *
Your Parents Full Name *
Your Parents Phone Number *
Your Parent's Email *
Your Gender *
Your Pronouns *
Required
Your Racial and/or cultural identity *
Do you agree to participate in at least 6 Heal Da Hood Circles? *
Required
Do you agree to participate in at least 6 Performance Development Sessions? *
Required
Do you agree to have a PG censored performance? You understand that if this is broken, your performance will be cut short and you will be disqualified? *
Required
You understand that you will be given a minimum of 10 tickets to sell for $20 and you will keep 50% ($10) of every ticket sold to aid in your audience participation for the performance? More tickets are available if requested. *
Required
Emergency Contact Name *
Emergency Contact Phone Number *
Relationship to Student *
ATHLETIC CONSENT FORM- The undersigned has read and understands the material contained in this form and hereby authorizes the student named above to participate in physical education and extra-curricular sporting activities including, but not limited to recreational sports (basketball, football, etc.), gymnastics, tumbling, dancing, etc. while enrolled in VPAC.By the very nature, athletic activities can put students in situations in which serious, catastrophic and perhaps fatal injuries may occur. These injuries could include, but are not limited to the following:❒Sprains/strains❒Head injuries❒Unconsciousness❒Disfigurement❒Cuts/abrasions❒Paralysis❒Fractures❒Loss of eyesight❒DeathStudents and parents must assess the risks involved in such participation and make their choice to participate in spite of those risks. No amount of instruction, precaution or supervision will eliminate all risk of injury. Although the school may suggest or recommend the use of certain equipment, the school does not guarantee that such equipment will be free from defects or protect the student from injury. By granting permission for your student to participate in athletic activities, you, the parent/legal guardian, acknowledge that such risk exists and assume these risks. Participation by your child is voluntary and is not required by the school. The undersigned has read and hereby agrees to hold​VICTORY PROJECT-BASED ACADEMICS & CAREER, its employees, agents, volunteers and/or sponsors and any other person, firm or corporation charged or chargeable with responsibility or liability, free and harmless from any and all claims, demands, damages, costs, expenses, loss of services, action and causes of action resulting from the use of facilities, equipment and participation by my student in the above named athletic activity, to the fullest extent of the law. *

LIABILITY- I accept and waive all liability to activities include dancing, auditioning, rehearsals and all events and activities organized by Victory Project-based Academics & Competency (VPAC), Auset Maryam, its board, volunteers, partners, Janice Crenshaw, any instructors Kids Above Everything, its board, volunteers, partners, Dane Washington or any entity associated to this project of Rock Da' Mic or Heal Da' Hood Healing Circles and its funders. I certify that my child and I are in good mental, emotional, spiritual, and physical condition.  I understand the inherent risks associated with performing dance activities and participating in VPAC activities and the effects afterward.


I agree not to sue and forever release, waive, and discharge VPAC and their respective employees, governors, affiliates, agents, partners, owners, members, parents, subsidiaries, representatives, officers, attorneys, sponsors, and players (hereinafter referred to as "Releases") from any and all liability to me, my child(ren), my personal representatives, assigns, heirs, dependents, pets, spouse and relatives for any and all claims, causes of action, losses, judgements, liens, costs, demands, that are caused by or arise from any injury, including death to me  or my property regardless of the cause(s) of such injury.  I assume all risks associated with my participation in and observation of the Activities.

I further grant releases the perpetual worldwide and royalty-free rights to use my or my child’s(ren) voice, photograph, and likeness in any media related to my or my child’s performance in or observation of a competition, rehearsals, performances, or training including, without limitation, a videotape recording of such Activities without compensation to me, or my personal representatives, assigns, heirs, children, dependents, spouse, or relatives.

I hereby acknowledge that I have carefully read this Liability Wavier and Release of Liability, that I fully understand its content, that I am signing this Liability Waiver and Release of Liability voluntarily and intend for it be legally binding in the State of Colorado. 

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STUDENT MEDIA RELEASE FORM- VPAC requests your permission to reproduce through printed, audio, visual, or electronic means activities in which your pupil has participated in his/her educational program. Your authorization will enable us to use specially prepared materials to (1) train teachers and/or (2) increase public awareness and promote continuation and improvement of education programs through the use of mass media, displays, brochures, websites, etc. ​At most, we would use your child’s first name, last initial, and grade level​. a. I, as a parent or guardian, of the above named pupil fully authorize and grant ​VPAC​ and its authorized representatives, the right to print, photograph, record, and edit as desired, the biographical information, name, image, likeness, and/or voice of the above named pupil on audio, video, film, slide, or any other electronic and printed formats, currently developed, (known as “Recordings”), for the purposes stated or related to the above. b.I understand and agree that use of such Recordings will be without any compensation to the pupil or the pupil’s parent or guardian. c.I understand and agree that ​VPAC ​and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in the Recordings. d.I understand and agree that ​VPAC ​and/or its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above. e.I hereby release and hold harmless ​VPAC and/or its authorized representatives from any and all actions, claims, damages, costs, or expenses, including attorney’s fees, brought by the pupil and/or parent or guardian which relate to or arise out of any use of these Recordings as specified above. Granting permission is voluntary. By checking yes, I confirm that I have read and understand the release and I agree to accept its provisions. *
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