Participant Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

T-shirt size *

Child S

Child M

Child L

Adult S

Adult M

Adult L

Adult XL

Home Phone

(###)

###

####

Cell/Other Phone

(###)

###

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WAIVER/CONTRACT TO BE SIGNED BY PARENT/GUARDIAN OR PARTICIPANT (must be 18 or older to agree) *

I, for myself or as parent or guardian, hereby assume all risks and hazards incidental to the conduct for the activities and transportation to and from the activities. I release, absolve and indemnify Encore! Youth Productions, its employees and volunteers, Pine Springs Preparatory Academy, and any contractors or sponsors, from all risks and hazards associated with the activities, and in the event of injury, I do expressly waive all claims against them. I understand that no insurance coverage is provided by this program and its sponsors. I/We also will allow the participants to be photographed/videoed for PR and marketing purposes. By entering my/our name(s) and clicking the box below, I and the participant will abide by all rules and guidelines of both Encore! and the Pine Springs Preparatory Academyv. My child understands that he/she must be respectful and responsible and learn lines and songs in a timely manner. Participants are expected to be present at each rehearsal.

I agree to the terms and conditions above.

Participant signature

First Name

Last Name

Parent/Guardian signature *

First Name

Last Name

Signature Date *

MM

DD

YYYY