Program Registration

Student Information

First Name: *

Last Name: *

Student Phone Number: *

Student Email: *

Mailing Address: *

Street * City: * State: * Zip: * Country: *

Sex: *

Race: *

Parent/Guardian Information

First Name: *

Last Name: *

Parent/Guardian Phone Number: *

Parent/Guardian Email: *

Household Income: *

School/Activity Information

Program: *

School: *

School District: *

Graduation Year: *

How many hours a week do you spend in performing arts activities: *

Does your school offer performing arts activities? If yes, which ones: *

What do you hope to learn/do in the program? *

Instrument (if applicable):

How did you hear about us? *

Questions or comments?

Photography Consent and Release

On behalf of myself and my minor child[ren], I hereby give permission to Kimmel Center, Inc., f/k/a Regional Performing Arts Center, its affiliates, parents, subsidiaries, assignees, and designees (together, the “Kimmel Center”), to use, copyright, and publish photographs, digital images, and video or motion pictures of me and my minor children, without restriction as to changes or alterations (“Artwork”), in Kimmel Center materials and publications, including but not limited to web sites, newsletters, brochures, and marketing or trade materials. I hereby release the Kimmel Center and its agents from any liability, demands or damages of any kind that may occur in the creation, production, or publication of the Artwork, including without limitation any claims for libel or invasion of privacy.

All negatives, positives, electronic versions, and printed copies of, and any and all copyrights in, the Artwork are the sole and exclusive property of the Kimmel Center. I hereby acknowledge that I have no right to any compensation from the Kimmel Center for the use of the Artwork and waive any claimed right to proceeds the Kimmel Center may generate therefrom. I hereby waive any right that I may have to inspect and/or approve the finished product, the advertising copy, or any other matter that may be used or created in connection with the Artwork, or the use to which the Artwork may be applied.

I confirm that I have the full power and authority to grant the permissions specified above, that I am 18 years of age or older, and that this consent and release shall be binding upon me, my child, and each of our heirs, legal representatives, insurers, and assigns, and intending to be legally bound.

By checking this box, you agree to the Photography Consent and Release. *

Your Initials: *

Education Program Liability General Release

I understand that individuals attending the Kimmel Center and participating in the Kimmel Center Education Program (the “Program”) must comply with all Kimmel Center rules and instructions, and must maintain appropriate behavior at all times. I acknowledge that the Kimmel Center reserves the right to refuse entrance to any individual or to require any individual to leave the premises when, in the sole judgment of the Kimmel Center, such act is necessary in the interest of the individual’s and/or the public’s safety or of other Program participants, or in the event the individual fails to act in an appropriate manner or in accordance with the rules, policies, or procedures of the Kimmel Center.

I acknowledge that I am fully aware of and assume all risks, known and unknown, associated with my child’s or my own participation in the Program. In consideration of participation in the Program, I , on behalf of myself, the child identified below, and each of our heirs, legal representatives, insurers, and assigns, hereby release, indemnify and hold harmless Kimmel Center, Inc., f/k/a Regional Performing Arts Center, its affiliates, parents, subsidiaries, assignees, and designees, and their directors, officers, employees, agents and assigns (together, the “Releasees”) from any and all liabilities, injuries, damages, and/or claims of any nature whatsoever, including but not limited to any personal injury or damage to property, arising out of or in any way related to attendance or participation in the Program. I understand that the Releasees are not liable for any incidents or circumstances involving my individual outside of the Kimmel Center building or outside of Program hours.

I give permission for myself and/or my minor child(ren) to participate in the Program using the Zoom video conferencing service. I understand that the live session may be recorded and may contain audio and video interactions that include my and/or my minor child(ren).

My signature below indicates that I agree to all the terms of this Liability General Release; have read, understood and freely signed this Liability General Release; approve my child’s participation in the Program; and that I am legally authorized to do so on my own behalf and on behalf of the child indicated below.

By checking this box, you agree to the Kimmel Center Education Program Liabiliy General Release. *

Your Initials: *