Work Study Program Application

  • Date Format: MM slash DD slash YYYY
  • Legal Disclaimer I hereby understand the potential risks involved in youth group activities and give permission for our child/youth, to attend and participate in St. Luke’s Performing Arts Academy Intensives. Should it be necessary, we (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician, licensed under the provisions of the Colorado Medical Practice Act or similar licensing laws, or the medical staff of a licensed hospital, whether such a diagnosis or treatment is rendered at the office of said physician, dentist, or at said hospital. By checking the Legal Disclaimer box during registration, the undersigned shall be liable and agree to pay all costs and expenses incurred in connection with any medical, dental, hospital or other services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child/youth to return home due to medical reasons or otherwise, the undersigned shall assume all costs including, but not limited to, transportation, lodging, meals, and other related costs. The undersigned also hereby give permission for our (my) child to ride in a vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities sponsored by St. Luke’s Performing Arts Academy. The authorizations contained in this Parental Consent Form can only be revoked in writing, signed by the persons who registered the minor and/or whose signatures appear below, and hand delivered to the Executive Director of the St. Luke’s Performing Arts Academy. Furthermore, I authorize Performing Arts Academy to have the right to copyright, publish, use, sell or assign any photographs, television/videos, and sound recordings, that have been taken of my child during PAA activities.

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