STG Program Participant Information

Program Information

This form is used to collect basic contact, waiver and emergency-related information for artists participating as participants, performers and/or presenters in STG's Education and Community Engagement Programming.

Please indicate which program you are currently participating in:

Participant Contact Information

First Name:

Last Name:

Preferred Pronouns

School Name (if applicable)

Performing Group Name (if applicable)

Email

Mobile Phone

Home Phone

Street Address

City

State

Zip

Unisex T-Shirt Size

Unisex Hoodie Size

Check here if you are under 18

Parent/Guardian Contact Information

First Name:

Last Name:

Email

Mobile Phone

Street Address

City

State

Zip

Check here if you are under 18

Health/Emergency Information

Emergency Contact Information

Check here if same as Parent/Guardian

First Name:

Last Name:

Mobile Phone

Work/Other Phone Number

Email

Other Health Information

List any medical conditions, disabilities or access needs:

List any special allergies or dietary needs:

List any medications participant will bring:

Waiver/Release

I recognize that risk of illness and/or injury may be inherent in any dance or onstage performance; however, the above individual is participating with the express agreement of, and understanding that Seattle Theatre Group and its directors, officers, employees and agents are hereby released from any and all claims, costs, liabilities, expenses, or judgments associated with this training program. I hereby execute and deliver this Waiver and Release form to induce Seattle Theatre Group to permit participation in the program indicated above.

I hereby grant the Seattle Theatre Group staff and volunteers permission to administer first aid and/or call 911 in the case of a medical emergency while I/my child is attending classes, rehearsals, and performances. I realize and understand that Seattle Theatre Group will attempt to notify parents and/or guardians in case of an emergency.

Injury/First Aid Agreement:

I agree

Photo Release

I hereby understand that Seattle Theatre Group may take photographs and/or video of the participant indicated in this form, and I authorize Seattle Theatre Group to use these photographs and video for archival and publicity purposes.

Photo Release:

I agreeI do not agree

Code of Conduct

I will respect the facilities, participants, artists and staff of this program and understand that this is a youth and/or adult program and I will use discretion and appropriate conduct while participating in this program to create a safe and welcoming environment for all.

Yes, I agree