Name of Participant *

First Name

Last Name

Name of Parent/Guardian if participant is under 18 *

First Name

Last Name

Participant's Birthdate *

MM

DD

YYYY

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone Number *

(###)

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Emergency Contact Phone Number (optional)

(###)

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Please read the terms below and check the box to agree. *

I am aware and familiar with the class that I have or my child has enrolled in. I acknowledge that there is a risk of injury when receiving instruction and at the times when I am without instruction. In consideration of the facility and location provided to me/my child, I forever release, discharge, and hold harmless Globus Theatre and any of its employees, representatives, or members from all liability or claim. Medical Emergency: I consent for any employee or representative of Globus Theatre to seek reasonable medical treatment, emergency or otherwise, at any time for me/my child. I agree to be liable for the cost of such treatment. Additional Waiver: I hereby grant Globus Theatre permission to lawfully photograph and/or videotape my child for educational or marketing purposes.

I, the parent/guardian, understand and agree with all the above terms.