Aristocats The Aristocats Kids The Aristocats Kids Student InformationName* Student First Student Last Street Address City State / Province / Region ZIP / Postal Code Students CellStudents Email Address* Student's AgeBirthdate* SchoolGradeParent InformationMother's NameMother's CellFather NameFather CellParent Email* Emergency Contact InformationIn the event a parent cannot be reached, please call:Emergency Contact CellCan the above person give permission for treatment?*YesNoSafety InformationPreferred Hospital*Please list any special dietary restrictions, physical restrictions, or health problems, including allergies, that we should be aware of:*I affirm that, except as noted above, my child is in good health and able to participate in all activities.*YesNoWith the understanding that safety standards will be met, I release New Day Children’s Theatre from possible claims for injury to person or property, which may arise from participation in all activities, and hereby agree to hold harmless New Day Children’s Theatre, its employees, agents, or representatives from any claim, liability, or expense arising out of or in any way connected with any alleged incident or injury resulting from such participation.*YesNoIn the event of a medial emergency, If parent or emergency contact is not available, I give the workshop director permission to transport myself or my child to a medical facility. I further give permission for the Director to seek any and all emergency medical treatment needed.*YesNoBy completing this form you are giving permission to be included in New Day's communication email list, and granting permission include you or your child's name and/or photograph in our advertising.YesNoParent Name: Completing this form- this will act as your signature.* This iframe contains the logic required to handle AJAX powered Gravity Forms.