PAC Players: After School Theatre
Information for Fall 2023 Participants
Sign in to Google to save your progress. Learn more
Student Name (First & Last) *
Date of birth *
MM
/
DD
/
YYYY
Preferred Pronoun *
Anything we need to know regarding child/or special considerations. *
PHOTO RELEASE I give permission for my child to be photographed and/or videographed in  Oregon Coast Council for the Arts activities. I understand and agree that all rights to these photographs and videos are reserved by and shall become property of the Oregon Coast Council for the Arts, and may be used by the Oregon Coast Council for the Arts, for promotion and publicity by the Oregon Coast Council for the Arts, including on the website, in print media, on television or online.   *
Name (First & Last) *
Email Address *
Primary phone (xxx-xxx-xxxx) *
Secondary phone (xxx-xxx-xxxx)
Emergency contact name (Cannot be parent or guardian listed above) *
Emergency contact primary phone (xxx-xxx-xxxx) *
Emergency contact secondary phone (xxx-xxx-xxxx)
Dietary restrictions *
Medical conditions and allergies *
MEDICAL RELEASE I agree to allow my child to receive medical treatment, should the need arise. I also give permission for my child to be transported to the nearest hospital in the event of a medical emergency. As parent and/or guardian of the above named child, I promise to hold Oregon Coast Council for the Arts harmless from any liabilities it may incur from the above named minor in connection with participation in art classes except as might arise because of negligence on the part of the Oregon Coast Council for the Arts.
Relationship to child *
Typing my name below will constitute by signature *
Date *
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Oregon Coast Council for the Arts. Report Abuse
Google Forms