Please complete the requested registration form with information about your teen.

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* 1. Teens First and last name? Age? Gender? DOB?

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* 2. What school does your teen currently attend?
What grade is your teen in for the 2020-2021 school year?

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* 3. What is your teens email?

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* 4. Does the participant require any ADA (Americans with Disabilities) accommodations?  If yes, please explain:

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* 5. Does the participant take any medications? If yes, please explain:

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* 6. Please tell us a little about your teen:

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* 7. Parent or Guardian completing this form?
Parent or Guardian Email address?
Parent or Guardian phone number?

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* 8. Please provide three emergency contacts for your teen.
Include emergency contact name and phone number.

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* 9. I give permission for the Participant named on this form to participate in the activities offered as part of Bristol Riverside Theatre’s ArtRageous Educational  program. I understand that any activity may expose the Participant to unanticipated risks and I release Bristol Riverside Theatre, its officers, agents, and employees, from any and all claims arising from any injury or damage resulting from participation in the activities, whether planned or unplanned.

I give permission to Bristol Riverside Theatre to take and use photography and/or videography that may include the Participant.

I understand that Bristol Riverside Theatre has the right to send participant home for the day or to deny Participant admittance to the camp for any conduct or behavior deemed inappropriate by Bristol Riverside Theatre.

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* 10. A) I give permission to Bristol Riverside Theatre to administer minor first aid procedures and obtain emergency medical care for Participant.
(Please type yes or no).

B) I give permission for ArtRageous staff to give my child Tylenol in the case of a headache or other minor pain.
( Please type yes or no).

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