Chorus Dance Registration Form

Chorus/Dance Registration

Child's Name(Required)

First Last

Birthdate(Required)

Grade level(Required)

Hidden

Age(Required)

Child identifies as(Required)

Does the child have a disability?(Required)

Yes

What is their primary diagnosis?(Required)

Are there any additional diagnoses?(Required)

Yes

What are the additional diagnoses?(Required)

Does your child have a behavior plan at school?(Required)

Yes

If your child does have a behavior plan, please upload a copy here.

Max. file size: 100 MB.

Does your child have any triggers to the behaviors?(Required)

Yes

If your child does have triggers, what are they?(Required)

Primary Contact(Required)

First Last

Phone(Required)

Email(Required)

Secondary contact (optional)

First Last

Phone for secondary (optional)

Email for secondary (optional)

Home address(Required)

Street Address City State ZIP Code

Child's phone (if applicable)

Hidden

Past Variety Theatre shows

Hidden

Past Variety Children's Chorus

Hidden

Past Variety Dance

For the 2023-24 school year, the child wants to participate in(Required)

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

I am the ward or guardian of above individual, (“the child”). I am responsible for the child and have authority to sign this release on behalf of the child.

Either the child by him or herself, I by myself, or the child and I together wish to participate in this event. There is no charge to us for our participation.

I understand that unless I sign this release, including all its terms, on behalf of the child and me, the Variety the Children’s Charity of St. Louis will not allow the child or me to participate in the event.

In order to participate in the event, on behalf of the child and myself, I therefore release the officers, directors, agents, affiliates, sponsors, volunteers, successors, assigns and employees of Variety the Children’s Charity of St. Louis from all liability for injuries or damages resulting from activities connected with the event, to the extent those injuries or damages are result of negligent acts.

I further agree to hold the released parties harmless and to indemnify them against any claims brought against them by third parties due to my actions and/or the child’s actions.

On behalf of the child and myself, I thus hereby release the released parties from all claims for damages or injuries for negligent acts connected with the event. I exclude from the release grossly negligent acts, intentional acts, and acts done with malfeasance.

I understand this release is quite broad, but I nevertheless accept its terms.

I acknowledge and agree to the Release, Indemnification, and Hold Harmless Agreement.(Required)

Yes

Media Release

I hereby authorize the media and/or representatives of the Variety the Children’s Charity of St. Louis to take photographs and/or videos of the child and me, and to publish and/or air those photographs and/or videos for the purposes of publicity and/or other reasonable purposes.

I acknowledge and agree with the Media and Photo Release.(Required)

Yes

Note: Declining the Photo and Media Release does not make your child ineligible to participate.

Covid Waiver

We understand that the child’s participation in this activity involves a risk that the child will get sick by contracting the COVID virus. We also understand that the child, like all children, is vulnerable to problems resulting from isolation. We agree that on balance it is worthwhile for the child to bear the risk of COVID infection in order to be able to participate in the activity.

We understand that it is impossible to both engage in life’s activities and be wholly risk free. We understand that one purpose of Variety is to help children engage in life’s activities.

We understand that while Variety will attempt to conduct the activity with reasonable COVID safety protocols in place, it will be impossible to conduct the activity with all such protocols in place at all times, and such protocols are not 100% effective anyway. COVID risks include at least involvement of many people, resistance to enforcement efforts, and people being in close physical proximity to one another.

We understand that if the child is eligible for vaccination, Variety requires us to either (a) provide proof the child is vaccinated against the COVID virus or (b) request an exemption and provide a reason for the request. We understand Variety will mandate the vaccine for employees, participants and volunteers, subject to those eligible for accommodation.

We accept that some of those involved in the activity will not be vaccinated, and we will not know who is and who is not vaccinated. We also understand that some children involved in the activity are immune-compromised and cannot be vaccinated.

We agree that if the child develops COVID symptoms we will immediately withdraw the child from the activity, we will inform Variety of the situation, we will have the child tested, and we will keep the child out of the activity until the child’s situation with COVID has abated.

Variety will inform us of any infections of any persons directly involved in the activity, but we understand that Variety reserves the right to continue the activity even if some people involved become infected. We, as parents, retain the right to remove the child from the activity at any time.

In exchange for the child having the opportunity to participate in the activity, we hereby release Variety from all COVID related liability which Variety might have as a result of the child’s participation in the activity. We understand that COVID can be fatal.

We further understand that if we do not sign this release and comply with its terms, and thus agree to bear the COVID related risks of participation in the activity, Variety will not allow the child to participate in the activity. Variety prefers all guardians or parents to sign, but a signature of one is binding.

Parent/Guardian 1(Required)

Parent/Guardian 2

The parties agree that this waiver may be electronically signed. The parties agree that electronic signatures appearing on this waiver are the same as handwritten signatures for the purposes of validity, enforcement and admissibility.