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$125

Child Name

Parent Name

Parent Email

This address will receive a confirmation email

Parent Phone

Address

How did you hear about Peace Preforming Arts?

What show/shows would you like to see come to Peace Preforming Arts?

Liability Release

By checking the box, I hereby release, discharge and agree to hold harmless Peace Church and its employees, volunteers and agents from any and all liability, claims or demands for personal injury, sickness, or other harmful occurrences resulting from my child's participation in this program. Furthermore, I agree to assume all responsibility for any of the previously mentioned occurrences. I give my permission for the personnel of Peace Church to secure emergency medical treatment as deemed appropriate at the medical facility they select. I agree to assume financial responsibility for this treatment. I understand that there is no special liability coverage in this program. I understand my child's picture may be taken and give permission for it to be used for the promotion of Peace Church's ministries.

Agree

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

If you have any questions please feel free to email our Director at Cameron@peace-eagan.org

Frozen $125

Description

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$125