Release Form

Broadway Bound Kids
Release Form
Please note: This form is not for Saturday Classes, Summer Programs, or Success Academy Classes.
Welcome to Broadway Bound Kids! We are thrilled that your child is joining us for one of our
performing arts programs and appreciate you taking the time to fill in the information below.
If you have any questions, please e-mail us at tim@broadwayboundkids.org.

* Indicates required field

Students Last Name *

Students First Name *

Student Birthday (mm/dd/yyyy) *

Address (Street Number, Street, Apt #, City, State, Zip) *

Home Phone Number *

Grade *

School *

What Class/Program Is Your Child Enrolled In? *

If Your Child is Enrolled in Multiple Classes, Please type the names of the Additional Classes Here. *

Parent / Guardian 1: FIRST NAME *

Parent / Guardian 1: LAST NAME *

Phone Number: Parent/Guardian 1 *

Email: Parent / Guardian 1 *

Parent / Guardian 2: FIRST NAME *

Name: Parent / Guardian 2: LAST NAME *

Phone Number: Parent Guardian 2 *

Email: Parent/Guardian 2 *

Does your child have any allergies or other restrictions? Is there any health information we should be aware of? If so, please provide that information here. *

comments? questions? Is there anything else about your child that you'd like to share? what he/she hopes to get out of the class? Other classes he/she would like? Favorite songs etc? *

Special Offers *

Check here if you do not want to receive occasional special offers for our Broadway Show Trips, Master Classes with Broadway Stars, Summer Programs, etc. We promise not to spam you! A few times a year we send out special offers and discounts for our programs.

I hereby certify that I am the legal guardian of the child listed above. Furthermore, I have read this release of liability and assumption of risk and fully understand its terms. (Please note that you must agree to these terms in order for your child to participate in Broadway Bound Kids programs.) *

AGREE

RELEASE OF LIABILITY I understand the nature of athletic activities and his/her experience and capabilities and believe my child to be qualified, in good health and in proper physical condition to participate in such an activity. In addition to giving my full consent for my child’s participation, I do hereby waive, release and hold harmless Broadway Bound Kids / EMG Artistic, its owners, representatives, instructors, directors, and employees for any injury that may be suffered by my child in the normal course of participation. I hereby give my permission to Broadway Bound Kids/ EMG Artistic to summon trained medical professionals to care for my child in the event that an injury should occur in my absence with the understanding that the family will be notified as soon as possible. I also certify that I have insurance to cover medical and dental expenses incurred in the treatment of my child. *

AGREE

PHOTOGRAPH & VIDEO RELEASE Broadway Bound Kids/ EMG Artistic may use photographs and/or video to promote Broadway Bound Kids/ EMG Artistic to the general public. I understand that I will not receive compensation in any form for the use of my child’s photograph, or my child’s photographic likeness in video, and/or recorded voice. I hereby consent to the use of my child’s photograph, my child’s photographic likeness and recorded voice in any video, and my first name by Broadway Bound Kids/ EMG Artistic, for use on the Broadway Bound Kids website and/or in any promotional posters, flyers, brochures, printed and electronic ads, electronic media, etc. CHILDREN'S NAMES WILL NOT BE USED. *

AGREE

Please double check your entries in the fields above as you will not be able to go back and make corrections. By typing your initials into the box below you are certifying that all of the information is correct and that you agree to the terms and conditions set forth in this agreement. *

Please click the "submit" button below and your release form will be sent.
We are so excited to have your child in our program and we look forward to seeing you soon.

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