Passing Strange - Childcare Matinee

Additional items

Student(s) Information

Primary Guardian Information

This should be the person who IS ATTENDING the performance

Secondary Contact Information

This should be someone who IS NOT attending the performance

Medical Waiver

I certify that I am the parent or legal guardian of the program participant named above and hereby give permission that my child may be given emergency medical care or first aid as determined to be necessary at the discretion of the Pasadena Playhouse or its employees, agents, or contractors. I also give permission for my child to be transported to any third-party medical facility, including without limitation any hospital, urgent care, or doctor’s office, for treatment if deemed necessary by the Pasadena Playhouse or its employees, agents, or contractors. If I or my preferred physician cannot be contacted in a timely manner, I further consent to any medical, surgical, and hospital care, treatment, or other procedures to be administered to or for my child when deemed by a medical professional to be immediately necessary or advisable to safeguard my child’s health and well-being.

I understand that if I provide health insurance information for my child, Pasadena Playhouse will make every effort to provide that information to any third-party healthcare provider who may administer treatment to my child, but Pasadena Playhouse is not responsible for determining whether or to what extent such third-party healthcare expenses will be covered by my insurance plan. I agree to indemnify, defend, and hold harmless the Pasadena Playhouse, its agents, servants, employees, volunteers, insurers, successors and assigns against any costs incurred for the treatment of my child, whether or not covered by insurance.

Photographic Release

I hereby give Pasadena Playhouse State Theater permission to use photographs or videos of my child in promotional material for future classes including social media, website, or in brochures, etc. I understand that these photographs will not be sold by Pasadena Playhouse, and my child may appear individually or in a group setting.

If you do not consent to the Photographic Release you must email education@pasadenaplayhouse.org with written refusal.