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Impact W19: Vocal 7th-8th Grade on Wednesday, January 16, 2019 @ 6:30 PM

Please enter the STUDENT'S NAME in the fields above. If the student does not have an email address or phone number, you may enter the primary parent's.
Impact Arts Academy will cancel registrations at no charge until January 1, 2019. After January 1st, a $25 cancellation fee per registrant applies. We will waive the cancellation fee if you transfer your registration to another available class after the January 1st deadline. After the deadline (beginning on January 2nd) we will unable to issue refunds except in cases of long term illness, injury, or a death in the immediate family.

*Parent's Full Name
*Child's Date of Birth
*Child's School
*Child’s Grade (2018-19 School Year)

Assumption of Risk Statement

I agree that if my dependent or I (heretofore known as "we") engage in any physical exercise, class, or activity, or facility on the premises or any venue where we participate as representatives of Impact Arts Academy/Perimeter Church, we do so at our own risk. I agree that we are voluntarily participating in activities and use of said facilities, premises (including the parking lot). We assume all risk of injury, illness, damage, or loss to us or our property that might result, including, without limitation, any loss or theft of any personal property. I agree that this consent and assumption of risk statement covers each and every event or activity sponsored by Impact Arts Academy/Perimeter Church.

I agree to release and discharge you (and your affiliates,employees, agents, representatives, successors, and assigns) from any and all claims or cause of action (known or unknown) arising out of your negligence. I am waiving any right that I may have to bring legal action to assert a claim against you for your negligence. As the legal parent or guardian, I release and hold harmless Impact Arts Academy/Perimeter Church, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Impact Arts Academy/Perimeter Church, its owners and operators or in route to or from any of said premises.

Photo/Image Release Statement

I give my consent for images (photographs, video) of my dependent to be taken and used to document the activities at Impact Arts Academy. I grant Impact Arts Academy/Perimeter Church permission to use the images for educational and promotional purposes. I understand that if I do not want images of my dependent to be used, I will indicate this in writing and submit this signed document to the Office staff at Impact Arts Academy/Perimeter Church.

Medical Emergencies Statement

The undersigned gives permission to Impact Arts Academy/Perimeter Church  its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. I request that our doctor/physician be called and that my child be transported to whatever medical facility deemed appropriate.