2023-2024 Marathon Center for the Performing Arts Education Program

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This form is to be completed for each person participating in educational programming at MCPA. This form only needs to be filled out one time during the 2023-2024 Season.

LAST Name of Participant *

FIRST Name of Participant *

PREFERRED Name of Participant

AGE of Participant *

GRADE of Participant *

GENDER of Participant *

Male

Female

Different Identity

Prefer not to say

RACE of Participant *

American Indian/Alaska Native

Asian

Black or African-American

Native Hawaiian/Pacific Islander

White

Other

Don't Know

Prefer not to say

ETHNICITY of Participant *

Hispanic/Latinx

Not Hispanic/Latinx

Other

Prefer not to say

Please list any facts concerning the child's medical history, including any physical or emotional challenges, that are important for us to know. *

Does the participant have any food allergies/sensitivities? *

Yes

If YES (food allergies/sensitivities), please explain. (What foods? What are the typical symptoms of a reaction? Are medications necessary in the event of a reaction?)

Does your child have any medications for emergency situations (e.g. EpiPen)? *

Yes

Does your child require medication administration during hours they will be at MCPA (e.g. insulin)? If YES, please be sure to bring the medication clearly marked with child's name and instructions for administration. *

Yes

Please use this space to provide any other information that is important for us to know about your child's physical, emotional, and/or mental health.

PARENT/GUARDIAN INFORMATION

What is your relationship to the participant? *

Parent

Guardian

Other/Relative

If OTHER/RELATIVE, please explain the your relationship to the participant.

PARENT/GUARDIAN Contact Information

Name (First and Last) *

Address *

City *

State *

Zip Code *

Email Address *

Phone Number *

In the event of an emergency and we are unable to contact you, please provide at least one (1) other person who we can contact. Please include the NAME and PHONE NUMBER of the contact. *

MINOR PARTICIPANT, PHOTOGRAPH, VIDEO, IMAGE and/or NAME RELEASE POLICY

MCPA will occasionally use photos from our events in our publicity material, including, but not limited to, our website, Facebook, brochures, etc.

Please choose one of the options below regarding MCPA’s photograph policy. *

I do authorize the release of my child’s photograph, image and/or name as “publicity/performance records”. I understand that a record of this request will be filed electronically at The Marathon Center for the Performing Arts and their photograph, image or name may be used in theater publications or other methods of information dissemination under the control of The Marathon Center for the Performing Arts.

I do not authorize the release of my child’s photograph, image and/or name as “publicity/performance records”. I understand that a record of this request will be filed electronically at The Marathon Center for the Performing Arts office and their photograph, image or name may not be used in theater publications or other methods of information dissemination under the control of The Marathon Center for the Performing Arts.

BEHAVIOR STANDARDS

Please follow these guidelines for all Art Education events:
• Be kind and respectful to participants and instructors!
• Listen and follow directions!
• Not using drugs, alcohol, or any other illegal substances
• Not engaging in any inappropriate behavior (including teasing, bullying, violence or inappropriate displays of affection)
• Obey rules!
• Demonstrate a positive attitude!
• Be prompt on arrival and departure!
• Show respect for your environment and the theater!
• Most importantly……Have Fun!!

Disrupting the learning environment and/or inappropriate behavior can be cause for dismissal from the program. Any participant that behaves in a manner that is inconsistent with expectations will be spoken to immediately by the education director, parent volunteer, teacher, teaching assistant or The Marathon Center for the Performing Arts board member. If no change of behavior is evident, the participant’s parent or guardian will be notified. If necessary, the child will be dismissed from the educational program and a refund will not be issued.

I have read and will comply with MCPA's Behavior Standards *

Yes

The Marathon Center for the Performing Arts Education Program PARTICIPATION, RELEASE, AND CONSENT FORM

I am the parent and/or legal guardian of the identified participant on this registration form. By and through my consent below, I do hereby give my authorization and consent for my child to participate in the Art Education Program sponsored by The Marathon Center for the Performing Arts. Further, I agree to release and hold harmless The Marathon Center for the Performing Arts, its Board of Directors, staff, agents or volunteers, against any injury, liability, loss, damages and/or expense, in law or equity, by any person or persons resulting from the administration, performance, planning, preparation, development, conduct, and execution of the Youtheatre Program. This form will be filed electronically.

I understand that my child will participate in MCPA Art Education programming during the 2023-2024 season. With advanced notice, times and dates may be adjusted.

I have read, fully understand and agree to the information above. *

Yes

For Youtheatre programs only: I understand that my child may be measured for a costume during the 2023-2024 year. *

I give Youtheatre volunteer's permission to measure my child for their costume.

I do not give Youtheatre volunteer's permission to measure my child. Therefore, I will be present to assist when my child will need to be measure.

N/A My child is not participating in the Youtheatre Program.

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