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Register Your Performer to Join Our Camp

Student Name:*

Entering Grade:*

Parent Name:*





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Camp Selection*

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Consent to release and waiver of liability form for participation in the

Red Barn Theater Camp instructed by Amy L. Gallo

Please read completely and carefully before signing

I grant permission for my child to participate in Red Barn Theater Camp.

I understand that the activities of this program may include certain physical activities such as swimming. I understand and agree to assume any and all risks associated with the Camp's activities.

I grant permission for my child to be photographed for purposes of publicity. I understand that some photographs may appear in local newspapers, web-sites, or brochures.

I grant permission for my child to participate in a video recorded performance which will be made available to camp families for the purpose of viewing the work of the child and nothing else.

I understand that if my child or anyone in the family becomes ill the child must stay home from camp to protect the health of others.

I understand that students must provide their own protective supplies such as sunscreen, insect repellant, and hand sanitizer. These items will not be provided or applied by the camp director.

If any illness, injury, or accident occurs which in the sole judgment of the staff of the camp requires immediate medical attention, I give consent for any member of the Camp staff to obtain such emergency treatment. I further consent to the signing of any releases by program staff, which may be required by any medical care provider. I understand that in the event of an emergency medical situation I will be notified as soon as possible. I also agree to provide the Camp staff with emergency contact numbers.

I further understand that the cost of any medical care deemed necessary for the treatment of any emergency illness injury, or accident occurring while my child is attending the Camp is my responsibility and that the Camp, Amy Gallo, John Noppenberg, or Marlene Noppenberg and their employees are not obligated to pay for such medical care. For the sole consideration of allowing my child to participate in this program, I hereby release and forever discharge the Camp and all it's members from any and all claims, demands, rights and causes of action of whatever kind that I may have either arising from or by reason of any personal injury or property damage resulting from or in any way connected with my child's participation in this program.

I further covenant and agree that for the consideration stated above I will not sue Red Barn Theater Camp, Amy Gallo, John Noppenberg, or Marlene Noppenberg for any claim for damages arising or growing out of my child's voluntary participation in this program or any of its activities.

I understand that the acceptance of this release, waiver of liability, and covenant not to sue shall not constitute a waiver, in whole or in part, of sovereign or official immunity by said Camp, its members, officers, agents, and employees.

I have received a copy of this document and I Certify I am at least 18 Years of age and that I have read the above carefully before signing. This Date (Date) (Month) (year)

Child's Name*

This day of *

Signature of Parent or Legal Guardian Printed Name*

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