Child *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Primary Contact *

First Name

Last Name

Primary Phone Number *

(###)

###

####

Permitted as a Parent/Guardian for Drop-Off/Pick-Up *

Please check one of the following

Yes

No

Secondary Contact

First Name

Last Name

Primary Phone Number

(###)

###

####

Permitted as a Parent/Guardian for Drop-Off/Pick-Up

Please check one of the following

Yes

No

Emergency Contact Information (other than those listed above)

First Name

Last Name

Primary Phone Number

(###)

###

####

Permitted as a Parent/Guardian for Drop-Off/Pick-Up

Please check one of the following

Yes

No

Does your child have any known allergies: *

Please check one of the following

Yes

No

Any known medical conditions that staff should be aware of: *

Please check one of the following

Yes

No

Does your child require any accessibility accommodations that you would like to share: *

Please check one of the following

Yes

No

Please mark ONE of the following options below and sign: *

I hereby grant the GCTC the irrevocable and unrestricted right to use and publish photographs or other images of me/my child, or in which I/my child may be included (formal and informal), in any print, electronic, digital or other media; and to alter the same without restriction. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these images. I irrevocably assign such images’ rights and uses to the GCTC into perpetuity. I hereby release the GCTC and its legal representatives and assigns from all claims and liabilities relating to said images, as long as no personal information or name is attached to any Photo or Video of my child/myself.

I do not allow the GCTC the right to use or publish photographs of myself/my child in promotional materials on Facebook, Instagram, or any other print, electronic, digital, or other media.

Part of the Summer Stage programming will include leaving the GCTC premises and visiting nearby parks for outdoor activities. If, for any reason, you are uncomfortable with your child participating in any specific activity, please feel free to let us know, and we will make the necessary arrangements to accommodate your preferences. We understand the importance of your child's safety and well-being, and we assure you that we will take all necessary precautions to provide a secure and enjoyable experience for each participant. *

I grant permission for my child to leave the GCTC premises for the Summer Stage outdoor activities. During outdoor activities, all participants will be supervised by the program staff.

I do not give permission for my child to leave the GCTC premises for the Summer Stage outdoor activities.

Please indicate one of the following: *

I, or another authorized parent/guardian, will sign my child in or out for drop-off and pick-up.

I authorize my child to sign themselves in or out for drop-off and pick-up.

*

I grant permission for my child to leave the GCTC premises during lunch hour. I understand that during this time, my child will not be supervised by the program staff, and they will be solely responsible for their actions and well-being. In the event that I want to revoke this permission or if my child's lunch hour activities change, I will notify GCTC in writing and provide reasonable time for them to make necessary adjustments.

I do not give permission for my child to leave the GCTC premises during lunch hour unsupervised.