In this document, “Staff” means any employee or independent contractor acting on behalf of Bardstreet LLC.
I, the parent or legal guardian of the child(ren) listed above permit our child(ren) to attend Programming held by Bardstreet LLC between August 1, 2026–July 31, 2027. As parent/guardian of the minor(s) listed above, I hereby consent and agree to hold harmless Bardstreet LLC and its Staff, for any accident, injury or occurrence arising out of, or in connection with, our child(ren)’s participation, including the transportation necessary to participate in aforementioned Programming. I hereby warrant that to the best of my knowledge, my child(ren) is in good health, and I assume all responsibilities for the health of my child(ren). I give my permission for my child(ren), in case of an emergency, to be taken to a physician or hospital by Bardstreet Staff. I understand that every effort will be made to contact me. If I cannot be reached, I hereby give permission to the physician selected by Bardstreet Staff to secure proper treatment for my child(ren).
Emergency Medical Treatment: In case of accident or illness of my child(ren), I request that Bardstreet Staff contact me. If I am unable to be reached, I hereby authorize this representative to call the physician indicated in this form and to follow the physician’s instructions. If it is impossible to contact this physician, Bardstreet Staff may make whatever arrangements seem necessary. In the event of an emergency, I hereby give permission Bardstreet Staff and any authorized adult designated by Bardstreet to supervise or transport participants to transport my child(ren) to a hospital and/or urgent care for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. I agree to assume the financial responsibility for any diagnosis, treatment, and/ or medication deemed necessary. To the best of my knowledge all information given in this form is accurate and complete. I acknowledge that it is my responsibility as parent or guardian to keep Bardstreet LLC informed of any changes in the information given in this form. I hereby consent to and authorize the necessary procedures that have been stated in this document.
Late Pick–up Policy and Fee: In the event you do not pick up your child(ren) after an individual Session of a Program part of Programming held by Bardstreet LLC between August 1, 2026–July 31, 2027, Bardstreet Staff will attempt to reach all emergency contact numbers, including parents or guardians at home, work and cell phone numbers, as provided by parent/guardian on this and/or registration form. It is your responsibility as parent or guardian to keep Bardstreet LLC informed of any changes in these contact numbers. If you know you are going to be unavoidably late, we ask that you notify us of the situation by texting Bardstreet LLC at (765) 237–9498. If you are more than fifteen minutes late, a late fee of $15.00 will be assessed, with an additional $1.00 per minute until your child(ren) is picked up. If you arrive more than thirty minutes late, an additional $5.00 per minute will be assessed until your child(ren) is picked up. Late fees are to be paid at the time of pick–up.
Media Release: On occasion, Bardstreet LLC takes photographs or makes an audio or video recording of Youth and/or Adults involved in Bardstreet LLC activities. Such photographs or video records may be used by Staff and participants to remember the activities or participants. In addition, such photographs and audio/visual recordings may be used in Bardstreet LLC publications or advertising materials to let others know about Bardstreet LLC. Also, local news organizations may learn about Bardstreet LLC’s activities or events, and Bardstreet LLC may invite or allow them to photograph or record such events to be used, distributed, or displayed as Bardstreet LLC sees fit. I hereby expressly grant to Bardstreet LLC, its assigns and transferees, the right, privilege, and license to copyright, use, edit, reproduce, and publish the picture or likeness of my child(ren) in any photograph, movie, video production, or any other forms of media publication taken for Programming held by Bardstreet LLC between August 1, 2026–July 31, 2027 and to use their verbal or written statements or declarations with or without name and for any lawful purpose in print and/or electronically, including casting and recruitment, audio–visual presentations, advertising, web content, social media channels, and fundraising of Bardstreet LLC, in furtherance of the mission of Bardstreet LLC. I release Bardstreet LLC and its Staff from any claims arising from the lawful use of such photographs, recordings, statements, or likenesses, and I understand and agree that the use of such picture(s), likeness(es), statement(s), or declaration(s) is not an invasion of privacy. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Bardstreet Code of Conduct can be found
here: Please go over the Bardstreet Code of Conduct. If you are registering child(ren) for Bardstreet Programming, please go over the Code of Conduct with your child(ren) in an age–appropriate way. In order to create a positive experience and develop work that is truly collaborative, educational, and high quality, there must be some ground rules in place. Thank you for your help in this matter!
