KIDOVATION STAGE
PROGRAM WAIVER FORM

Please complete the CAMP WAIVER form below PRIOR TO your child’s first day in our program(s):

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child #1 Name

First Name

Last Name

Child #1 Birthdate

YYYY

Child #1 Gender

Additional Children

Please list the names and dates of birth for any additional children registered for camp this year.

Allergies/Medical Conditions

Please list any allergies, diet restrictions, illnesses or chronic medical conditions for each child attending. If none, please write "N/A"

Emergency Contact(s) Info

We will only release your child to the persons listed below. Please list name, phone number and relationship for ALL adults authorized to drop-off/pick-up your child(ren):

Alternate Email

Please add any additional email(s) you'd like us to add to our listserv:

Tell us about your child(ren)

Please tell us about your child(ren) (i.e., fears, favorite activities, strengths, etc.):

KidOvation Stage Program Waiver

I. Liability Policies As a registrant of KidOvation Stage programming, I am aware that my purchase is non-refundable. This policy is subject to change by owners at anytime. I am aware that I am giving my child permission to take classes and that I will hold neither KidOvation Stage, its owners, and assigns liable for any injuries sustained while arriving and/or leaving the program location, participating in camps, taking classes, workshops or any instruction or performance related session. I release the aforementioned parties from any and all claims, suits, losses, or related causes of action for any kind of damages or injuries received in connection with my participation in classes, workshops and performances or related activities, including, but not limited to, such claims that may result from my injury or death, accidental or otherwise, during or arising in any way from or in connection with classes, workshops and performances. If my child has any particular injury or concern, I will consult with my physician before allowing my child to participate in any activity and inform KidOvation Stage prior to the event and exercise caution in all movements. By signing below, I acknowledge that I am aware of and agree to KidOvation Stage Liability Policies. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that KidOvation Stage, FKS Programs LLC and its venue partners/affiliates have put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that KidOvation Stage, FKS Programs LLC and its venue partners/affiliates cannot guarantee that my child will not become infected with the Coronavirus/Covid-19. Furthermore, I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to fellow members and their families. I voluntarily seek services provided by KidOvation Stage, FKS Programs LLC and its venue partners/affiliates and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while my child is in attendance in the program. II. Photo/Video Release: I hereby give permission to KidOvation Stage for the use and reproduction of photographs, video footage, or voice recordings of this event/ event for education and/or marketing and promotion by KidOvation Stage, including posts on website/social media sites, KidOvation Stage (YouTube and Vimeo Channel), documentary films, and other broadcast mediums, as well as for grant purposes. I hereby give consent that such photographs, film, audio, and video recordings may be used free and clear of any claim. KidOvation Stage does not discriminate against students on the basis of race, color, sex, marital status, religious creed, ancestry, national origin, handicap or sexual orientation. CONFIRMATION BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. ALL PURCHASES ARE NON-REFUNDABLE, TRANSFERS ARE AVAILABLE UPON REQUEST.

KIDOVATION STAGE PROGRAM WAIVER FORM

Please complete the CAMP WAIVER form below PRIOR TO your child’s first day in our program(s):

KIDOVATION STAGE
PROGRAM WAIVER FORM