Health-SafetyForm

Health & Safety Form - must be completed before your child may attend the Summer Theatre Academy
Please submit this form at least one week before the start of the Summer Academy.

* Indicates required field

Student Name *

First

Last

Parent / Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent / Guardian Email *

Primary Phone Number *

Secondary Phone Number *

Whose Phone / Relationship *

HEALTH AND WELFARE: In case of minor headache or muscle aches, I authorize the staff of the Young Actors Summer Theatre Academy to give my child (named above):

Asprin *

Acetaminophen (Tylenol) *

Ibuprofen (Advil) *

PHYSICAL or HEALTH RESTRICTIONS: Please list any Physical, Medical or Health Restrictions or Limitations.

Physical or Health Restrictions *

My child (named above) has no Physical or Health Restrictions *

YES - has restrictions NO - has NO restrictions

FOOD ALLERGIES or DIETARY RESTRICTIONS: Please note that we may not be able to accommodate all food for dietary requests with the provided meals. Breakfasts, Snacks and Lunches are provided by The Baltimore Summer Lunch Program and Baltimore School Food and Nutrition.

Food Allergies or Dietary Restrictions *

My child (named above) has no Food Allergies or Dietary Restrictions *

YES - has restrictions NO - has NO restrictions

TRANSPORTATION INFORMATION - How will your child be arriving and departing from the Theatre Academy *

Transported by Parent or Guardian Transported by someone other that Parent or Guardian Student will be "Self-Transported" - driving, public transit, etc

Please provide name of non-parent/guardian that will assist in transporting your child. *

PHOTOGRAPHY / VIDEO RELEASE: By registering your child for the Summer Theatre Academy, you grant permission for your child to be photographed in various activities during classes and performances. These materials are the property of Spotlighters Theatre and the Young Actors Academy, and may be used for various promotional work in print (newspaper. magazines) and various media (website, emails, and video) to promote the educational programs of Spotlighters Theatre.

Submit

Health & Safety Form - must be completed before your child may attend the Summer Theatre AcademyPlease submit this form at least one week before the start of the Summer Academy.

Health & Safety Form - must be completed before your child may attend the Summer Theatre Academy
Please submit this form at least one week before the start of the Summer Academy.