Admiral Theatre Stage Combat Adult Declaration & Release

ADMIRAL THEATRE / STAGE COMBAT DECLARATION & RELEASE DECLARATION BY ADULT ATTENDEE (Registration will not be considered final before tuition is paid and we have a signed declaration by all attendees).

I, the undersigned, being the adult attendee of this acting class, ____________________________________________________________________ (full name of attendee) declare that the information and medical details on this registration form are correct to the best of my knowledge and I at this moment apply for an enrollment space at the Admiral Theatre Education Program as indicated (adult attendee for Stage Combat class). I understand that the Admiral Theatre reserves the right to restrict admission at its discretion.

Participation and Medical Emergencies I certify that I am able-bodied and healthy to participate in all activities, except as indicated under ‘Medical History’, and I understand that the Admiral Theatre provides no health insurance or medical coverage and that the signing of this form acknowledges my responsibility for payment of any medical treatment which may be required during my participation in classes at the theatre.

I further grant permission for the Admiral Theatre or its representatives to procure any necessary medical help I might need and authorize the Admiral Theatre or its representatives to permit any competent medical person to take all reasonable measures to treat any injury or sickness I may need help for.

Release By signing this form, I hereby state that I release all members of the Admiral Theatre staff and any other party involved in the organization and administration of the Admiral Theatre from any liability as a result of any injury sustained in or around the Admiral Theatre venue.

Photo Release I grant permission for any and all photographs taken at the Admiral Theatre to be used by the Admiral Theatre or its representatives in displays or for advertising in, but not limited to, newspapers, magazines and brochures. I understand that no personal information will be associated with any photographs without my consent and that no 1

compensation is offered. I also understand that all photographs taken by the Admiral Theatre are the property of the Admiral Theatre.

Privacy I understand that all information supplied on this form will be kept strictly confidential and that the Admiral Theatre will never divulge any personal information to a third party without my consent.

I have read and understand the above declaration.

Signed

Print Name

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