Student's Name/Nombre de Estudiante *

First Name

Last Name

Parent or Guardian's Name/Nombre de pariente *

First Name

Last Name

*Electronic Signature - By typing my full name in the box below, I acknowledge that I have thoroughly read, understand, and agree to the conditions listed on this page. I understand that Studio Playground, its affiliates, and their respective officers, directors, trustees, members, employees, and lessors, are released from liability or damages or injury to my child resulting from their attendance in the Performing Arts in Libraries Program with Studio Playground which will occur February 3 - May 15, 2025 at Community Libraries of Providence: Wanskuck Library, located at 233 Veazie Street, Providence, Rhode Island 02904. *

LIABILITY & PROCEDURES WAIVER I consent to my child's participation in class activities, including running, jumping, warm-up, and physical acting. I understand there are inherent risks in such physical activities, and I assume all risk of injury that may occur. My child will decline to participate in any activity that would put their well-being at risk due to a pre-existing condition. I do hereby for myself, my child, and any heirs, executors, and administrators, assign, waive, and release from any and all liability, whether caused by negligence or otherwise. For the purposes of this release, liability means all claims, demands, losses, causes of action, suits, judgements, and and claims for damages which I may have, or which may hereafter accrue to me against Studio Playground, its affiliates, and their respective officers, directors, trustees, members, employees, and lessors. I consent that my child may self-report to class and self-dismiss. I take full responsibility for my child's safety should I decide not to escort them at the beginning and end of class. I have read the above agreements and understand that Studio Playground is released from liability for any damages or injury to my child resulting from their attendance in the Performing Arts in Libraries Program with Studio Playground which will occur February 3 - May 15, 2025 at Community Libraries of Providence: Wanskuck Library, located at 233 Veazie Street, Providence, Rhode Island 02904. AUDIO AND VIDEO RELEASE Participation in class acknowledges agreement that Studio Playground may record and store video and audio of class participants for learning purposes, marketing, and class projects. Studio Playground will own the recordings, including photographs, digital images and audio/video recordings and all rights related to them. The recordings and images may be used in any manner or media, such as promotions, publications, social media, and the Studio Playground website. You may opt out of the photo policy by selecting the box at the bottom of this form. I acknowledge that I understand the content of this document and agree to the above terms. I am aware that it is legally binding and I sign it out of my own free will. *Electronic Signature - By typing my full name in the box below, I acknowledge that I have thoroughly read, understand, and agree to the conditions listed on this page. I understand that Studio Playground, its affiliates, and their respective officers, directors, trustees, members, employees, and lessors, are released from liability or damages or injury to my child resulting from their attendance in the Performing Arts in Libraries Program with Studio Playground which will occur February 3 - May 15, 2025 at Community Libraries of Providence: Wanskuck Library, located at 233 Veazie Street, Providence, Rhode Island 02904.

First Name

Last Name

Date *

MM

DD

YYYY

You may opt out of the photo plicy by selecting the box below.

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