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Please sign publicity release and liability waiver:

Emergency Contact: Who should we contact in the event of an emergency during class? Name : ___________________________ Phone : ___________________________ Relationship: _______________________. Please sign publicity release and liability waiver:

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Please sign publicity release and liability waiver:

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  1. Emergency Contact: Who should we contact in the event of an emergency during class? Name: ___________________________ Phone: ___________________________ Relationship: _______________________ Please sign publicity release and liability waiver: I, ________________________________ , hereby grant permission to Webster Studio, LLC to use my/my child’s photo image and/or likeness in its promotional materials. I recognize that said materials are property of Webster Studio, LLC to be used at its discretion for purposes of marketing and promotion including, but not limited to, print media advertising, press releases, feature media/articles, radio and television news, and website. I waive any claim to royalty or compensation due for photo usage. ___________________________________ Signature __________________ Date Liability Waiver I, ________________________________ , for myself / my child do hereby release, forever discharge and agree to hold harmless Webster Studio, LLC and its staff from any and all liability in the event of an accident incurred by the undersigned and/or the child participant while said is in class or on the premises or participating in any Webster Studio, LLC activity off/on premises. ___________________________________ Signature _______________ Date Payment Information Weekly Classes: Full payment is due on the first of each month. There are no refunds for classes missed due to student absenteeism. Initial ____________ Remit payment to: Webster Studio, LLC 238 Fillmore Street, Staunton, VA 24401 434.465.9017 www.groovecatcomedy.com

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