Medical and Photo Release Form

Name(required)

OHIP#(required)

Emergency Contact (name)(required)

Emergency Contact (phone #)(required)

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?(required)

Is your child on any medication?(required)

Does your child have any allergies? Please specify(required)

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(required)

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.(required)