Scene Study Workshop Registration Form — Creative Arts Council of Wells County


Scene Study Workshop Registration
Student's First Name
Student's Last Name
Student's Birth Date (if under 18)	// (mm/dd/yyyy)
Student's Parents' Name(s) (if under 18)

Address
City
State/Province
Zip

Primary Cell Phone Number (will be used to receive text reminders)

Secondary Phone Number

Primary Email
Secondary Email

Waiver
I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage. I understand that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc. I understand the risks involved by allowing my child to participate in the Creative Arts programming during the COVID-19 pandemic. Because of this, I will not hold responsible the Creative Arts Council of Wells County, its staff, volunteers, board, or instructors if I/my child contracts COVID-19. I understand that I/my child will be expected to participate in procedures used by the Creative Arts Council in order to minimize the transmission of the virus. Such procedures will be implemented by Creative Arts Council staff/instructors and include washing hands, using hand sanitizer, temperature checks, maintaining social distance, etc. Further, I understand students should not attend Creative Arts programs if they have experienced COVID-19 symptoms (coughing, shortness of breath, etc.) within the last 72 hours, had a fever within the last 72 hours, and/or has been exposed to someone with COVID-19 within the last 7 days. I understand Creative Arts will add my contact information to email campaign/text messaging software in order to communicate information to me about Creative Arts programming. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time. I agree to pay a resource fee in order for my spot to be held. By checking the box below, I agree to the above listed terms and conditions established by the Creative Arts Council of Wells County, and acknowledge that checking this box will act as a digital signature.
	I agree

* A confirmation will be sent to your email address with information regarding tuition payment. *