Elizabeth Anne Carlson Performing Arts Foundation Master Class in the Performing Arts
Saturday, October 21st, 2023
9:00 a.m.-4:00 p.m.
Greater Hartford Academy of the Arts
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Please complete and return this form NO LATER THAN Saturday, October 14th 2023.

Student Name *
Street Address, City, State, Zip Code
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Student Cell Phone
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School *
Age
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Grade (Fall '23)
 *
Parent/Guardian Name
 *
Parent/Guardian Cell Phone
 *
Parent/Guardian Email
 *
Emergency Contact and Phone Number
 *
PUBLICITY/PROMOTIONAL ACTIVITIES:
Portions of the Carlson Foundation Master Classes may be photographed and/or filmed for promotional purposes including but not limited to a website, brochure, photos, newspaper ads/features or promotional/archival videos. Does the Carlson Foundation have your permission to use your child’s image/name in promotional photos/videos (group or individual)?
*

ALLERGIES AND MEDICAL CONDITIONS:

Please List any and all Allergies or Medical Conditions that our staff should be made aware of:

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PARTICIPATION PERMISSION SLIP AND RELEASE:

I approve of my child, named above, participating in the 2023 Master Classes in the Performing Arts presented by the Elizabeth Anne Carlson Foundation. As the student’s parent/guardian, I release the Carlson Foundation, and the facility where the Master Classes will be held, from all liability, damages, or claims whatsoever from any injury or harm that may occur to my student while participating in the Master Classes provided. I will look to my own resources, insurance, or assets to pay all medical bills, damages, or losses whatsoever in any injury occurs. The term Carlson Foundation includes all employees, staff, and volunteers participating in the 2023 Master Classes in the Performing Arts. I also give permission to release my child to my emergency contact listed above if needed.
By signing the section below you will agree to this release
Parent/Guardian Signature and Date
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