Registration InformatioN Student's Name * First Name Last Name Which program, camp, or class are you registering? * Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent or Guardian #1 Full Name * Parent or Guardian #1 Email * Parent or Guardian #2 Full Name * Parent or Guardian #2 Email * Emergency Contact Full Name * First Name Last Name Emergency Contact Relationship to Student * Does your child do gymnastics? Which tricks can they perform? * Do you give your child permission to perform gymnastics at RTB programming? * Yes No Does your child have any food allergies? * Yes No If Yes, What are they? Do they require an EpiPen? * Will your student be signed out every day? * Yes No Any other information you'd like us to know? Photo Release: Do you grant permission for your child or yourself to be photographed or recorded for promotional purposes related to Rhode to Broadway content? * Yes No Liability Release/Emergency Treatment: I certify that my child can tolerate all normal physical activity. I, the undersigned parent/guardian, grant permission for my child to receive necessary medical treatment in the event they sustain an injury or illness during my absence. I understand that if my child has a medical condition that requires an assigned assistant in a school setting, either I or the child’s assistant must be present at all times. I acknowledge and understand that participation in this activity presents the possibility that my child may sustain physical injury or illness. I hereby release Rhode To Broadway, its employees, officials, and agents from any liability connected to my child’s participation in the program. * Yes No Thank you!
