MINOR PARTICIPANT HOLD HARMLESS, INDEMNITY & RELEASE

Production

Select the show you have been cast in.

Cast/Crew Member Name

First Name

Last Name

Date of Birth

YYYY

Age At The Time Of Program

1. Acknowledgment of Risk I understand that participation in MainStage productions—including auditions, rehearsals, performances, and related activities—may involve physical movement, use of stage equipment, technical elements, and collaboration with others in a theatrical environment. I recognize the inherent risks of injury or illness (including from physical activity or environmental exposure), and I voluntarily allow my child to participate under the direction and supervision of Lake Country Playhouse & Academy (“LCP”).

2. Programming Locations I understand that programming may take place at both of the following locations: Lake Country Playhouse: 221 E Capitol Dr, Hartland, WI 53029 The First Congregational Church of Hartland: 111 Church St, Hartland, WI 53029 I grant permission for my child to participate in activities, rehearsals, and performances held at either or both locations as part of this production.

3. Release of Liability To the extent permitted by Wisconsin law, I hereby release and discharge Lake Country Playhouse, its directors, officers, employees, contractors, volunteers, and venue partners from any claims of injury, loss, or damage—except in cases of gross negligence or intentional misconduct. I understand this release does not waive any rights under Wisconsin law where such waivers are prohibited and is intended to be construed narrowly and reasonably.

4. Hold Harmless & Indemnification I agree to hold harmless and indemnify LCP and its representatives from any claims, damages, or costs arising from my child’s participation in the program, including legal fees, unless caused by willful misconduct or gross negligence.

5. Medical Authorization In the event of an emergency where I cannot be reached, I authorize LCP staff or volunteers to seek appropriate medical attention for my child. I accept financial responsibility for any resulting treatment.

Health Insurance Provider:

Policy #

Emergency Medical Information

Please list any medical conditions, allergies (including food, medication, or environmental), or other health concerns we should be aware of in case of an emergency. If none, please write "None." This information will be kept confidential and only used to ensure your safety during rehearsals and performances.

Emergency Contract Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Release for Unsupervised Departure - (Ages 12+ ONLY) - If your child is 12 years or older, you may authorize them to leave the rehearsal/performance premises unsupervised to walk home or visit nearby businesses (e.g., library, coffee shop, gas station):

Yes, I grant permission for my child to leave the premises unsupervised.

No, my child must remain on-site unless released to a parent/guardian.

Details (optional – e.g., restrictions, usual destinations):

Governing Law & Severability This Agreement shall be governed by the laws of the State of Wisconsin. If any part of this agreement is deemed unenforceable, the remaining provisions shall remain in effect.

Acknowledgment & Signature I acknowledge that I have read, understood, and voluntarily agree to the terms of this release. I understand I may request clarification or revisions prior to signing.

Signature

(Parent/Guardian Signature for cast members under the age of 18)

First Name

Last Name

Date Signed

YYYY