EAST Spoken Word/Poetry Collective Registration Form

EAST Spoken Word/Poetry Collective Registration Form
Sign up for FREE workshops that explore poetry, spoken word, performance and creativity!
Name: _____________________________________________________________________________
Date of Birth & Age (must be between the ages of 12 and 18):_________________________________
Address: ___________________________________________________________________________
Phone #: ______________________________________________________________________
Email: _____________________________________________________________________________
Parent/Guardian name (if under 18): _____________________________________________________
Parent/Guardian phone # (if under 18): ___________________________________________________
Please select the Toronto Public Library workshop location that you would like to register for:
 Agincourt Branch (155 Bonis Avenue) May 13-June 14, Tuesdays 4-5:30pm
 Malvern Branch (30 Sewells Avenue) June 21-July 26, Saturdays 2-3:30 pm
 Morningside Branch (4279 Lawrence Avenue E.) August 2-September 6, Saturdays 2-3:30 pm
 Cedarbrae Branch (545 Markham Road) September 13-October 11, Saturdays 2-3:30 pm
Please see the attached second page for consent forms.
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Please return BOTH pages of the completed form in one of the following ways:
Email: east@scarborougharts.com
Fax to: 416-698-7972
Mail/drop off to: Scarborough Arts, 1859 Kingston Road, Toronto, M1N 1T3
Drop off at the Information Desk of the workshop location branch (checked off above)
Bring to the first day of the workshop
Questions? Call 416-698-7322 or email east@scarborougharts.com
EAST Spoken Word/Poetry Collective – Consent Forms
Consent for Persons Under 18
I hereby grant permission for ________________________________________ to participate in the EAST Spoken
Word/Poetry Collective at the above selected branch location and dates. In consideration for their participation in the
EAST Spoken Word/Poetry Collective, I hereby waive any claims and/or causes of action against Scarborough Arts their
officers, directors and employees, as well as program facilitators.
Name of Participating Individual
Name of Parent/Guardian (for individuals under 18)
Signature of Participating Individual
Signature of Parent/Guardian (for individuals under 18)
Date
Consent for Persons Age 18
In consideration for my involvement with the EAST Spoken Word/Poetry Collective I, _____________________________,
hereby waive all claims and/or causes of action against Scarborough Arts, their officers, directors and employees, as well
as program facilitators.
Signature of Participating Individual
Date
Media Consent
I, ________________________________________, hereby grant my permission for Scarborough Arts
(Name of parent/guardian if participant is under the age of 18. Name of participant if he/she is 18 years of age)
and/or partners to record, film, photograph, audio record or video record my/my child’s name, image, work and
performances (hereinafter collectively referred to as “works”) and to display, publish or distribute these works for the
purpose of display, promotional and educational purposes.
I understand that the works may appear in electronic form on the internet or in publications outside of Scarborough Arts’
control. I agree that I will not hold Scarborough Arts responsible for any harm that may arise from such reproduction.
I also understand that external media organizations may attend EAST and Scarborough Arts events. I give permission for
my/my child’s name, image, work, and performances to be photographed, filmed, audio record or video record for the
purpose of being published and/or broadcast online, on television or radio.
By signing this document, I agree to me/my child participating in recorded EAST and Scarborough Arts sessions and events
and media events that may be published or broadcasted by organizations external to Scarborough Arts. I have read this
Media Release Consent Form and fully understand the contents and meaning of this release. I understand that I am free to
contact the Manager – Youth Programs with questions regarding this release.
Name of Participating Individual
Name of Parent/Guardian (for individuals under 18)
Signature of Participating Individual
Signature of Parent/Guardian (for individuals under 18)
Date