After School Drama at Grand Avenue Public School (Grades 1-4)

Child's First Name: *

Child's Last Name: *

Child's Age: *

Child's Pronouns (e.g. she, he, they): * She/Her He/Him They/Them Other

Parent/Guardian Full Name: *

Email: *

Phone Number: *

Full Name of Secondary Emergency Contact: *

Secondary Emergency Contact's Phone Number: *

Names of Other Adults Approved for Pickup:

Special Considerations & Allergies:

Media Release: Carousel Players takes photographs and video recordings during our educational programming. Carousel Players maintains copyright of these images and manages their distribution. These images and videos may be published in/on Carousel Players’ brochures, posters, electronic newsletter, social media, website, and annual report to demonstrate and promote our work The images may also be shared with our funders and sponsors to demonstrate the work that Carousel Players does.: * Yes: I give Carousel Players permission to take photos and/or videos of my child participating in program activities No: I do not give Carousel Players permission to take photos and/or videos of my child participating in program activities.