IYT/IYT JR Registration

2021-2022 Season

HEALTH HISTORY INFORMATION

Because performance can be a highly physical activity, it is necessary that the following information concerning health history be provided.  Please remember that all information is considered important and confidential.

General Release/Indemnification

In case of an emergency, if the staff of Gary Taylor Dance/Imagine Youth Theater is unable to reach me by phone, concerning a situation that requires immediate emergency medical assistance, I hereby give my permission to the staff to secure treatment for my child as named in this application.  As an additional consideration, I release Gary Taylor Dance/Imagine Youth Theater from liability for injuries to the person or property of the student, which may occur while participating in the activities of this company.  In addition, I will not hold Gary Taylor Dance/Imagine Youth Theater responsible for any theft, accident or injury during any Gary Taylor Dance/Imagine Youth Theater function or activity.

Gary Taylor Dance/Imagine Youth Theater shall have the right to use the name, photograph, video-tape, voice, or other likeness of the student; and to exhibit the same through any medium whatsoever during the term of this agreement or at any time in the future for advertising, promotional or commercial purposes.  All such reproduction shall be the exclusive property of Gary Taylor Dance/Imagine Youth Theater.

CERTIFICATION