A non-profit organization ● Energizing community through live performance Pantages Theater ● Rialto Theater ● Theater on the Square ● Tacoma Armory

Emergency Contact Form

Student Information
Emergency Contact information

Please provide name and phone number of someone in the event a parental/guardian cannot be reached.

Authorized Pickup Persons

Please provide name and phone number of persons authorized to pick up the student, other than the Emergency Contact Person.

Special Needs

Allergies and Special Behavioral Consideration (e.g. asthma- carries inhaler, serious peanut allergy- no nuts in classroom, ADHD, ODD, etc.). Help us meet your child’s needs:

Insurance Information
Agreement

Please read and check the box below.

Photography Release
I give the Broadway Center for the Performing Arts absolute rights and permission to publish and/or copyright photographs of myself and/or my child. These photographs may be used for marketing and publicity purposes, in any medium, without compensation to myself and/or my child. I hereby waive any right to inspect or approve of the finished product, including written copy that may be created within said photographs.

Limit of Liability
I agree to hold the Broadway Center for the Performing Arts, its board of directors and employees free and harmless from any and all claims, costs, losses, damages, recoveries, settlements, and expenses of any nature or kind, which may be incurred by participation in classes and activities at the Broadway Center for the Performing Arts or satellite venues used by the Broadway Center for the Performing Arts.

Behavioral Expectation
Disruptive or disrespectful behavior is not tolerated and will result in immediate dismissal from the program without refund.

More than two (2) late pickups (more than 10 minutes after the scheduled end time) will result in removal from the class without a refund.

Security:

(Please click within the "I'm not a robot" box.)*