CMT Teen Conservatory Summer 2023

ADVANCED THEATER INTENSIVE FOR AGES 13-20

  Teen Conservatory Class Details

Please fill out a separate form for each child.  


Sign in to Google to save your progress. Learn more
Email *
Student Name: (Last, First) *
Age: *
Address: *
Phone: *
Class Selections(s)
Allergy Info: Please email us if you/your child has allergies we should be aware of.   Authorization to Consent to Medical Treatment:  I (We), the undersigned, do hereby authorize representatives of Children's Musical Theaterworks of Fresno (such representatives to be employees, directors, Auxiliary members or identified volunteers) to serve as agents for the undersigned to consent to an X-ray exam, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the provisions of the Medicine Practice Act on the medical staff of any hospital licensed by the State of California whether such diagnosis or treatment is rendered at the office of said physician or  at said hospital or some other site. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of the aforesaid agent to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem available. I (We) also understand and agree that CMT of Fresno will not be held responsible for injuries which occur to self/child while attending or participating in any CMT of Fresno function. This authorization shall remain valid for the duration of the participant's current registration with CMT of Fresno. *
Required
Waiver of Liability: As the parent/guardian of the above-named child and/or on behalf of myself and/or my child, agents, heirs, and successors, I voluntarily agree to: 1) assume all risks of injury, illness, or death to myself or my child arising out of or resulting from participation in and/or attendance at the above-stated program or activity, such risks to include but are not limited to, injury, illness, or death due to being exposed to or infected by contagious diseases, including COVID-19; 2) waive and release all claims, causes of actions, actions, liabilities, and costs against CMT and its staff and board and members thereof, officers, employees, agents, and volunteers, and hold harmless CMT from any claims, causes of actions, actions, liabilities, and costs that may arise out of or result from my child’s participation in or attendance at such program or activity; and 3) assume all obligations for any medical, financial, and other costs and/or liabilities that be sustained or incurred by my child, myself, or my agents, heirs, and/or successors. CMT assumes no responsibility and shall not be liable for any injury, illness, death, liabilities, damages, or costs that my child, myself, my agents, heirs, and/or successors may sustain or incur arising out of or resulting from the aforementioned program or activity. *
Required
Full Rules, Refund Policy and Other Requirements:  Full Rules, Refund Policy, Requirements



 *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of cmtworks.org. Report Abuse
Google Forms