2022 Fall Class Registration
Registration forms for Special Needs Shining Stars class
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Email *
STUDENT INFORMATION
Student's Name
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Student's Date of Birth
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Student's Address
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Parent/Guardian/
Responsible Party Name
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Parent/Guardian/
Responsible Party Phone number
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Parent/Guardian/
Responsible Party Email Address
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Emergency Contact's Name
Emergency Contact's Phone Number
Student's Preferred Pronouns
LIABILITY WAIVER:
 
Pertaining to  Productions, Auditions, Rehearsals, Meetings, Workshops, Camps, Classes and Community Events of the Youth Artist Guild Lubbock ("YAGL") and The EDGE Theatre ("EDGE"). As parent/guardian of the aforementioned child/children I hereby release and discharge the above named organizations, it’s agents, employees, and sponsors, from all claims, demands, actions, judgments, and executions which I may have or which my heirs, executors, administrators, or assigns may have, or claim to have against the above named organization, it’s successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or rising out of the above signed activities. I authorize the activity's authorized designee to secure any and all emergency medical care and treatment for my child for acute illness suffered or injury sustained while participating in said activities. I understand that the costs of the services provided by ambulance, private physician, clinic, hospital, or dentist remain the responsibility of the parent or guardian and will not be assumed by the  YAGL and/or EDGE , or any of it’s members or associates. I, the undersigned, have read this release and consent to medical treatment and understand all its terms. I execute it voluntarily and with full knowledge of its significance.
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Required
PHOTO/VIDEO WAIVER:
Youth Artist Guild Lubbock ("YAGL") and The EDGE Theatre ("EDGE"), through its staff and instructors, will often record and/or photograph  YAGL and/or EDGE classes and other educational programs to use as YAGL and/or EDGE promotional material. Such promotional material may include, but not be limited to, social media posts and advertising, both physical and virtual.  YAGL and/or EDGE will retain full rights to and interest in these recordings and photographs. By participating in   YAGL and/or EDGE classes and programming, students understand and acknowledge that both in-person and virtual classes may be recorded and/or photographed, and that they, as a participant, will also be recorded and/or photographed. By allowing the student to participate in   YAGL and/or EDGE classes and programming, parents/guardians give permission for  YAGL and/or EDGE , through its staff and instructors, to take recordings and/or photographs of their child during in-person and virtual classes. If a student, or parent/guardian on behalf of the student, does NOT consent to being recorded and/or photographed, they must promptly inform the Class instructor or mentor about their concerns and the reasons for them. Students should understand that this choice may limit their participation in performances that are routinely recorded and/or photographed. Students who do not wish to be recorded and/or photographed must be proactive in avoiding being recorded and/or photographed during   YAGL and/or EDGE classes and programming. By checking this box, students and parents/guardians acknowledge that they will hold  YAGL and/or EDGE harmless if a recording and/or photograph of the student is released despite all precautions. *
Required
MEDICAL INFORMATION FOR STUDENT

In case of injury or serious illness, I hereby grant permission for Youth Artist Guild Lubbock and/or The EDGE Theatre agents, employees, or sponsors to secure medical services for the child identified above. 

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Required
Physician's Name and Phone Number
Insurance Company and Policy Number
Drug or Food Allergies
Medical Issues:
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Required
Other medical issues not listed above:
Parent/Guardian/Responsible Party's Signature (typed name will serve as signature) and Date

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If you forget to click on the link to pay after you submit your form, you can go directly here and do it from the form in your email. https://www.ticketor.com/yaglubbock/stars
A copy of your responses will be emailed to the address you provided.
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