Program Registration

THE ENTERTAINMENT CONSORTIUM, INC.

Child's Name /Address

Email

Age/Sex/Grade

Parent or Guardian's Name

Phone/Cell/Work

Emergency Contact/Relationship/Phone

Allergies/Medications

Does your child suffer from any medical, physical, emotional or behavioral conditions

YesNo

If yes, please specify:

I give my permission to secure medical attention for my child if I cannot be reached.

YesNo

I give TEC personnel permission to transport my child to/from Arts Programs and field trips:

YesNo

My child may be photographed/ videotaped by the program for performance or promotional purposes.

YesNo

I will hold TEC harmless from liability arising from program participation.

YesNo

Parent/Guardian Signature

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