Theatre Event Permission Form

THEATRE EVENT PERMISSION FORM

Event Details

Event Name:

Event Date:    Departure Time:    Return Time:

Event Location/Venue:

School/Program:    Teacher/Sponsor:

Student Information

Date of Birth:    Student ID#:    Grade/Program:

Home Phone:    Student Cell:    Student Email:

Parent / Guardian Information

Relationship to Student:    Primary Phone:    Email:

Emergency Contact Phone:

Medical Information & Authorization

Insurance Provider:    Policy Number:

I authorize school personnel to administer prescribed medications to my child as directed by the prescribing physician and as documented on medication instructions.

I authorize school personnel to provide routine first aid and over-the-counter medications (e.g., acetaminophen, ibuprofen, antihistamine) according to school policy if deemed necessary in an emergency.

Transportation & Fees

Transportation provided:   School bus/van    Chaperone private vehicle    District-approved driver in private vehicle

Event Fee / Ticket Cost (if any): $    Payment Method:

Photography & Publicity

I grant permission for photographs, video, or audio recordings of my child to be used by the school or program for educational or promotional purposes without financial compensation.  

I do NOT grant permission for photographs, video, or audio recordings of my child to be used.

Acknowledgement of Risk, Liability Release & Consent

I, the undersigned parent or legal guardian, hereby authorize my child named above to participate in the theatre event described on this form. I understand that participation may involve inherent risks, including travel to and from the event, and I accept responsibility for communicating medical needs and behavior expectations to the supervising staff.

I authorize the supervising staff to obtain emergency medical treatment for my child if necessary and consent to such treatment, including hospitalization, anesthesia, and surgery as recommended by licensed medical personnel. I agree to be responsible for expenses associated with such treatment and to provide insurance information when available.

To the fullest extent permitted by law, I release and hold harmless the school district, its employees, volunteers, agents, and contractors from claims, demands, liabilities, or causes of action arising out of or related to my child’s participation, except for acts of gross negligence or willful misconduct. I further agree to indemnify the school for claims arising from my child’s intentional or reckless conduct.

By checking this box I certify that I have read, understand, and agree to the statements above and that the information provided on this form is true and correct to the best of my knowledge.

Code of Conduct & Behavioral Expectations

Students are expected to comply with the district’s code of conduct while participating in this event. Disciplinary action, including early removal from the event or loss of future privileges, may result from violation of rules or unsafe behavior. Chaperones and school staff have authority to enforce standards of conduct.

I acknowledge that I have reviewed the behavior expectations with my child and understand the potential consequences for misconduct.

Additional Information

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