Release & Authorization Forms - Elisha American Artistic Preparatory Academy

Release and Authorization Forms

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Scholar Name

First

Last

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian Name

First

Last

Phone

MEDICAL RELEASE AGREEMENT

Does the student have any medical conditions that would prohibit full participation in courses or specialized dance / athletic programs that Elisha American Artistic Preparatory Academy offers?

Please give the name, address, and phone number of student’s primary care physician:

Medical Release Terms & Conditions

Please select this box to indicate that you agree to the terms and conditions below.

1. YOUR AGREEMENT
The information provided by me in this release form is, to the best of my knowledge, accurate and true. As indicated by my signature below, I authorize Elisha American Artistic Preparatory Academy personnel, and its affiliates to consent to any emergency treatment of my minor child (named above) which may be deemed necessary. This may include emergency transportation, examination, anesthesia, medical diagnosis, surgery or treatment, and/or hospital care of the minor child upon the advice of a physician or surgeon licensed to practice medicine in the United States of America. I acknowledge that I will be responsible for any cost incurred by this treatment. I understand that Elisha American Artistic Preparatory Academy does not provide health insurance to students. This authorization shall be deemed valid for twelve months (12) from the date of signing during the 2025-2026 school year only.

By agreeing to this release form, you agree to be bound by, and to comply with, these Terms and Conditions. If you do not agree to these Terms and Conditions, please do not use tick the box.

PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.

Parent/Guardian Signature

Clear Signature

Date

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This media release form grants permission for your scholar's image or likeness to be used in school-related media.

Deadline: June 1

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Parent/Guardian Name:

First

Last

Scholar Name

First

Last

Media Release Terms and Conditions

I, the parent or guardian of the above named scholar, has read the terms of this release before signing below, and I fully understand the contents, meaning and impact of this release.

1. YOUR AGREEMENT

- I agree to grant permission to Elisha American Artistic Preparatory Academy, hereinafter known as the “Media”, the right to photograph, videotape, or otherwise digitally collect student’s likeness, voice, and sounds (as “Works”) during the student’s enrollment at Elisha American Artistic Preparatory Academy.
- I hereby waive any rights to inspect the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any rights to royalties or other compensation arising from or related to the use of the image.
- This gives Elisha American Artistic Preparatory Academy the right to use or sublicense the Works and student names, likenesses, and biographies, in Elisha American Artistic Preparatory Academy’s discretion, in all media, for the promotion of Elisha American Artistic Preparatory Academy and its mission, vision, and program.
- Elisha American Artistic Preparatory Academy events are semi-public events that may be attended by members of the press, business corporations, and media (“commercial guests”) not under the control of Elisha American Artistic Preparatory Academy who might photograph or videotape the event.
- Elisha American Artistic Preparatory Academy asks all commercial guests to comply with the Elisha American Artistic Preparatory Academy policy by not printing a minor’s name with his/her picture, and Elisha American Artistic Preparatory Academy asks them not to use images of the participants or attendees for any commercial purposes without obtaining specific written permission from the person or a minor’s parent or guardian.

By agreeing to this media release form, you agree to be bound by, and to comply with, these Terms and Conditions. If you do not agree to these Terms and Conditions, please do not use tick the box.

PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.

Signature of Parent/Guardian

Clear Signature

Date

Print Name

First

Last

Relationship to student

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Your child’s safety is of the upmost importance to us. As a result, the E.A.A.P.A. requires this permission form to be completed for each child. Unless otherwise noted, any adult listed must show a photo ID when picking up your child. They will also be required to come in and sign your scholar out. The E.A.A.P.A. is not responsible for any travel arrangements for E.A.A.P.A. scholars once they leave the school grounds.

Form Deadline: July 31

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Release and Authorization Forms

MEDICAL RELEASE AGREEMENT

I give permission to the following adults (18 and older) to pick up my child from school:

Authorized By: