Education Waiver

Please Complete the Education Waiver Below. Education waivers must be completed before students can attend any CCT education programs.

Student Information
Child's Name*
First Last
Child's Age (at program start date)*
What grade is your child in?*
List rising grade for summer camps.
Child's Birthday*
Month
Day
Year
What school does your child attend? (if applicable)*
What pronouns does your child use?
- He/Him/His
- She/Her/Hers
- They/Them/Theirs
- Other
Child's Pronouns (if not listed above)
Parent/Caregiver Emergency Contact Information
Primary Contact Name*
First Last
Primary Contact Relationship to Child*
Primary Contact Relationship to Child (Other)*
Primary Contact Email*
Primary Contact Cell Phone Number*
Primary Contact Address*
Street Address Address Line 2 City State ZIP Code
Secondary Contact Name*
First Last
Secondary Contact Relationship to Child*
Secondary Contact Relationship to Child (Other)*
Secondary Contact Email*
Secondary Contact Cell Phone Number*
List all adults authorized to sign out/pick child up from class or camp. Include name and relationship.*
Medical Information and Waiver of Liability
Does your child have any allergies or a medical condition that our staff should be aware of? If yes, please describe.
Does your child carry an EpiPen or other emergency medication?*
- Yes
- No
What type of emergency medication does your child carry?
- EpiPen, Auvi-Q, or other epinephrine injection
- Benadryl, or other antihistamine
- Other (please list below)
You selected "Other". What type of emergency medication does your child carry?
EPIPEN CHECK-IN POLICY
All Epi-Pens, Auvi-Qs, and other emergency medication must be checked in with CCT Education Staff for the duration of your child's camp day, This ensures that all staff can access the medication easily in case of emergency.

For classes during the school year, your child can keep their EpiPen/emergency medication in their own backpack without checking it in.
I acknowledge that I have read, understand and agree to the terms outlined above.
What symptoms should staff look for before administering emergency medication?
Does your child take any non-emergency medications that will need to be administered by CCT staff?*
- Yes
- No
Medication Name
Medication Dose
When to Administer the Medication
For example, time of day or after observing specific symptoms.
Any Other Medication Information
What is your preference for checking in your child's medication during camp?
For classes during the school year, your child can keep their EpiPen/emergency medication in their own backpack without checking it in.
- Pick-up and drop-off medication every camp day
- Leave medication checked-in with CCT for the entire camp
- Leave medication checked-in with CCT for the entire camp, but take it home on the weekends
MEDICATION WAIVER
I, the parent/legal guardian of the above named student, give permission for my child to take their prescribed medication during the camp day in the circumstances, times, and manner described on the backside of this form.

By signing this statement, I am also acknowledging that Chicago Children’s Theatre, its employees and agents, are to incur no liability, except for willful and wanton conduct, as a result of any injury arising from the self-administration of medication or use of an epinephrine auto-injector by the student. I agree to also indemnify and hold harmless CCT and its employees and agents against any claims, except a claim based on willful and wanton conduct, arising out of the self-administration of medication or use of an epinephrine auto-injector by the student.

I acknowledge that I have read, understand and agree to the terms outlined above.
What learning tools, behavioral strategies, or accessibility accommodations can we provide in class to support your child?
CCT strives to create accessible and inclusive spaces for students of all abilities and all learning styles. If you have provided this information to us before and the information has not changed, please note that here.
Authorizations
COVID-19 POLICIES*
By attending class or camp at Chicago Children's Theatre you are agreeing to abide by our COVID-19 policies. To view our most up to date COVID-19 policies, please refer to our Education FAQ at the link below.

https://chicagochildrenstheatre.org/education-policies-faqs/

If you have any questions or concerns about our COVID-19 policy, please email sam@chicagochildrenstheatre.org.
I acknowledge that I have read, understand and agree to the terms outlined above.
PARENT/GUARDIAN AUTHORIZATION & WAIVER OF LIABILITY*
Please read this form carefully and be aware that in registering yourself and your minor child/ward for participation in the above program or programs to be conducted at or in cooperation with Chicago Children’s Theatre, you, for yourself and as the parent or legal guardian of the child named above, will be waiving and releasing all claims for injuries that you and your child might sustain arising out of or in connection with such program or programs.

I certify that all of the medical and other information listed is complete and accurate to the best of my knowledge. I hereby give permission for my child to participate in all Chicago Children’s Theatre programming and activities. I recognize and acknowledge that there are certain risks of physical injury to participants in the program listed above and I agree to assume the full risk of all injuries, damages, or losses regardless of severity which I or my child or ward may sustain as result of participating in any activities connected or associated with any such programs and I waive and relinquish all claims I or my child or ward may have against Chicago Children’s Theatre and its officers, directors, employees, agents, contractors, and volunteers as a result of participating in all activities and programs in connection with Chicago Children’s Theatre. Furthermore, I acknowledge that I have received, read, and understand Chicago Children’s Theatre policies and procedures, and agree to abide by the policies and procedures and hereby grant the permissions stated therein.

I hereby give my permission for Chicago Children’s Theatre and their employees, staff, contractors, and volunteers to secure from an accredited hospital, clinic, and/or physician any treatment deemed necessary for my child or ward’s immediate care. Further, I acknowledge and agree that I shall remain responsible for any and all expenses incurred for such emergency care and treatment.

In the event of incident, Chicago Children’s Theatre will contact parent/emergency contacts of child(ren) immediately.
I acknowledge that I have read, understand and agree to the terms outlined above.
CODE OF CONDUCT*
Chicago Children’s Theatre aims to provide an environment that is supportive of all campers and their abilities. We encourage campers to conduct themselves appropriately throughout the camp day with respect to our Teaching Artists, camp staff, and to other campers. CCT Camp Staff will devise a code of conduct with campers on the first day of camp. Please go over the following expectations with your child prior to camp:

1. Be Safe (hands to self, no hitting, rough-housing, or running inside)
2. Be Kind (no bullying, use kind words, be inclusive, listen to teachers)
3. Give it a Try (try new things even if you're not sure that you'll like them!)

If there are any extreme behavior incidents in class or at camp involving your child, you might receive a call home or we will check in at the end of the day in order to best work with you to find the best behavior strategy for your child.
I acknowledge that I have read, understand and agree to the terms outlined above.
USE OF IMAGES*
Chicago Children’s Theatre occasionally takes photographs and/or video of children/students enrolled in our programming and may use of your child or ward’s name, photograph, voice or creative work(s) in electronic/digital or print media, promotional materials, and archives. You acknowledge that no compensation in any form will become due to you, your child or ward, your heirs, or agents upon use of media. You agree to use of images by enrolling in our programming. If there is a concern please contact Sam Mauceri at sam@chicagochildrenstheatre.org.
- I acknowledge that I have read, understand and agree to the terms outlined above.
- I do not consent to the use of images.
CONSENT TO GO TO THE PARK - FOR CAMPS ONLY*
I consent for my child or ward to be walked, under the supervision of Chicago Children's Theatre staff, to and from Skinner Park, weather permitting. I agree to assume the full risk of all injuries, damages, or losses regardless of the severity which I or my child or ward may sustain as result of participating in any activities connected to traveling to and from and playing at the park.
I acknowledge that I have read, understand and agree to the terms outlined above.

Education Waiver

Student Information

Parent/Caregiver Emergency Contact Information

Medical Information and Waiver of Liability

Authorizations