Children’s Playhouse Theater Registration Form For LCS at Fairfax Ave. Location
In case of emergency and we cannot reach either parent, whom do you wish us to notify?
Name of person(s) authorized to pick child up from class (other than parent)
- I/We, the undersigned parent(s)/guardians of the above named child, a minor, do hereby authorize Children’s Playhouse Theater (CPT) and Jason Pace and/or any other CPT teacher to act as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any accredited hospital, whether such diagnosis, treatment or hospital care being required but is given to provide authority and power on the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable. This authorization is given pursuant to the provisions of section 25.8 of the California Civil Code. We also give Children’s Playhouse Theater LLC and Jason Pace and/or any teacher at CPT permission to provide transportation for our child in case of emergency. This notice also absolves Children’s Playhouse Theater LLC, Jason Pace and staff blame or responsibility for any injury my child may incur while participating in class or show functions. I further agree to allow my child to be used in any promotional photographs/video and I am aware and agree that all written & produced materials are the property of Children’ Playhouse Theater LLC and Jason Pace.
- I understand that all fees are non-refundable. No refunds or make-ups will be offered for days absent from camp.
Above ER/REGISTRATION FORM must be signed and submitted ON or PRIOR to the ﬁrst day of camp.
In the event my child needs special accommodations, it is my responsibility to inform the Executive
Director, Program Director and counselors to arrange alternative options.
I am aware of the possible dangers and injuries that may arise during my child’s participation in strenuous physical activity. I hereby afﬁrm that my child is in good physical condition and does not suffer from any disabilities that would limit or prevent their participation in this physically exerting program.
In the event that my child will not be attending due to illness or absence due to personal reasons it is my responsibility to inform the Executive Director & Program Director via TEXT stating FIRST & LAST NAME OF CHILD. Contact numbers to be issued on the ﬁrst day of camp.
All late pickups after 3:05PM are subject to a $2/per minute fee. At 3:15pm Full After Care Fee will be charged.
All Children must come to camp daily with a packed snack & lunch.
Please Note: If your child's behavior is deemed disruptive to the Daily Activities or to other children, Children's Playhouse Theater will notify you immediately. If the disruption continues, Children's Playhouse Theater will give you second notice, at which point Children's Playhouse Theater reserves the right to terminate your contract/attendance without refund. The purpose of this policy is to ensure that the camp experience is amazing for all of our children in attendance.
- I acknowledge that Hollywood Schoolhouse (HSH) or Children’s Playhouse Theater, LLC (CPT) assumes no responsibility for any injury associated with the voluntary participation in any and all organized camp & pool activities by the below-named student. I further understand that these camp & pool activities involve some risk, injury or even death. After weighing these risks against
the potential benefits, my son/daughter may gain from these activities; I freely and fully accept the risks on my child’s behalf.
With full understanding of the risks involved,
2015 Spring Camp Dates
2015 Summer Camp Dates