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Alley Theatre Matinee Field Trip
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Registration
$20.00
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Participant's First Name
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Participant's Last Name
Gender
Male
Female
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Date of birth
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Current Grade
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Allergies
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Any medical history we should know
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Do we have your permission to take your child to the nearest doctor or hospital should in our opinion the situation warrant this action?
Yes
No
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The Doctor on call, or Doctor contacted, has my full permission to treat or render emergency care.
Yes
No
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Who is your family doctor?
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In case of an emergency, where may we reach him/her?
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Please list name and phone number of nearest responsible party.
Please give two contacts
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Please acknowledge and agree that I understand that all students are governed by the same rules on this trip as at school. I understand that any infraction may result in disciplinary action. I hereby release the Pasadena Independent School District, the School, and all adult leaders from any liability and from any and all claims against them, individually or collectively, for any injuries which might be received during this field trip or activity, or in traveling to or from such field trip destination.
I agree
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