Parental Permission For Minor Child to attend Drop-In Teen Improv Night at Schaumburg on Stage Studio
I ______, the parent of ______(“my child”), give permission for my child to attend any scheduled Teen Improv Drop-In Nights at Schaumburg On Stage’s performing arts studio located at 1925 Wright Blvd. In Schaumburg On Stage.
In the event that a personal injury or illness occurs during event hours, I hereby authorize an adult staff member of Schaumburg On Stage to seek and consent to emergency medical attention for my child as needed in the event that I cannot be immediately available. I further acknowledge that any treatment reasonably rendered to my child in connection to a medical emergency shall be covered at my own expense.
I hereby release Schaumburg On Stage, its employees, agents and volunteers, from any and all liability, claims, demands, causes of action and possible causes of action whatsoever arising out of or related to any loss, damage or injury (including death) that may be sustained by my child while participating in or traveling to and from this event.
I understand that the Improv hours of operation are from 7 p.m. until 9 p.m. on each occasion that a Teen Drop-In Improv night is held, and that I/my child am/is responsible for securing transportation to and from Schaumburg On Stage Studios at 1925 Wright Blvd., Schaumburg, Illinois at the conclusion of the event or in the event that my child is dismissed from the event for unsafe or inappropriate behavior.
______
Signature of Parent and Date of Signature
(Permission slip expires one year from initial signing)
Emergency Contact Information:
Mother’s Cell Number: ______
Father’s Cell Number: ______
Home Phone Number: ______
Please list any known medical conditions or allergies that Schaumburg On Stage should be made aware of:______.
If you have any questions or in the event of an emergency, please contact Mary Alice Benoit, Executive Director of Schaumburg On Stage, at 630-632-8911.