MYTP Form: General

WELCOME TO Milton Youth Theatre Productions! Please fill out the general waiver form below as you have signed up to participate in an MYTP drop-in program. For your convenience: This only needs to be completed once per year.

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Student's Full Name

Gender

Date of Birth (Year/Month/Day)

Address

Postal Code

City

Parent/Guardian 1

Parent/Guardian 2

Email 1

Email 2

Home Phone Number

Cell Number 1

Cell Number 2

Emergency Contact (name)

Emergency Contact (phone #)

Has your child ever suffered from asthma, heart problems, breathing problems or any other medical condition that may affect his/her ability to participate in this program?

Is your child on any medication?

Does your child have any allergies? Please specify

Does your child have any behavioral or alternative accommodations? Please specify.

Injury Waiver: Each student and his or her legal guardian(s) hereby release Milton Youth Theatre Productions and Directors, Teachers and Employees from claim for personal injury sustained in, on or about the facilities

Photography & Video Waiver: Each student and his or her legal guardian(s) hereby release Milton Youth Theatre Productions the rights to all photography and video that may be taken by or for Milton Youth Theatre Productions during classes or performances, for use in advertising and promotion, including television coverage.

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