Liability Release *
I understand that my minor child is participating in Season 23 of the Contemporary Youth Orchestra. I hereby release, indemnify, and hold harmless CYO, its directors and officers, employees, successors, assigns, legal representatives, organizers, sponsors, and supervisors of its activities from any and all claims, causes of actions and liability arising from or in any way connected with my child’s participation with CYO.
Medical Release *
I hereby consent, during my absence, for all medical and/or surgical treatment and/or special procedures which may be required during our absence,. Without in any manner limiting the foregoing appointment and authorization, if circumstances permit, I would like to have our doctor (stated below) consulted in connection with such medical and/ or surgical treatment and/or special procedures.
Media Release *
Please check here if you give CYO permission to use photographs and video of your child in its publicity efforts and as part of commercial releases of CYO performances for both private and public consumption.
Emergency's Contact Name *
Emergency's Contact Name
Emergency Contact's Phone Number *
Emergency Contact's Phone Number
Physician's Name *
Physician's Name
Physician's Phone Number *
Physician's Phone Number
Please list any conditions of which we should be aware: