In consideration of my child/children participating in this Learning at the Levoy program, I on behalf of myself, my heirs, personal representatives, and all those claiming by or through me consent to, and so hereby discharge and release and forever hold harmless The Levoy Theatre Preservation Society, Inc. d/b/a The Levoy Theatre and their affiliates, sponsors, agents, servants, employees, assigns, successors, and heirs and any facility at which events are held, from any and all claims, actions, losses, damages, or expenses for personal or bodily injury (including death), and property lost or damage of whatever nature or cause, incurred by me (or my child) arises out of or any conjunction with my (or my child's) participation in the aforementioned event. I hereby consent that I am of legal age and have read and understand the contents of this consent and release.

I give permission for the above-mentioned student(s) to attend class and workshops at the Levoy Theatre. I agree that the Levoy Theatre will not be liable if injury to the student(s) occurs during the said class and/or time spent in the Theatre before and after class. In the event of a medical emergency, Levoy Theatre has my permission to call for medical emergency assistance and if required, to allow my child to be transported to an emergency room by medical professionals. The Levoy Theatre will notify me or persons listed above if an emergency arises and what actions is being taken at that point.

List any information that you believe is pertinent to the instructors or medical emergency personnel.