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Texas Thespians Medical Release Form

Educator Professional Development 2026


Medical/Photo/Video Consent Form

TEXAS THESPIANS, an affiliate chapter of the Educational Theatre Association, requires that this form be completed for each delegate (students and adults) attending any TEXAS THESPIAN EVENT.

  • If a delegate is a minor (under 18), a parent or legal guardian must complete this form
  • The delegate (and family) is responsible for any fees incurred from a medical emergency
  • If you substitute a delegate, you must supply a new completed health form
  • Type or print legibly
  • Enter name exactly as it appears on the registration form


I. RELEASE

The undersigned hereby releases and agrees to indemnify, save, and hold harmless the TEXAS THESPIANS, the International Thespian Society, the Educational Theatre Association, and all respective officers, employees, agents, and representatives of the aforementioned entities (each an "Organizer" and collectively the "Organizers") from and against any and all claims, demands, causes of actions, losses, liabilities, judgments, damages, costs and expenses (including reasonable attorneys' fees) resulting from the Delegate listed above participating in the TEXAS THESPIANS STATE FESTIVAL, JUNIOR THESPIAN FESTIVAL, TROUPE DAY, SHORT PLAY CONTEST and EDUCATOR CONFERENCE. The undersigned shall give each Organizer prompt written notice of any claim or facts or circumstances that might give rise to any claim for indemnification. The undersigned further agrees to be responsible for the Delegate while traveling to and from TEXAS THESPIAN EVENTS, including any expenses incurred by the Delegate, caused by the Delegate, and/or any personal injuries that may occur to the Delegate. The undersigned authorizes the Delegate to be released to the Troupe Director or Chaperone listed on this form.

II. RULES AND REGULATIONS

The undersigned agrees that the Delegate shall abide by the TEXAS THESPIANS security rules and regulations (as described in detail at www.texasthespians.org). The undersigned understands that, if the Delegate violates any of the TEXAS THESPIANS EVENTS security rules and regulations, the Delegate may be returned home, and the undersigned (or other parents and/or legal guardians) may be financially responsible for all necessary costs incurred while sending the Delegate home. The undersigned also understands that TEXAS THESPIANS will follow its posted refund policy for all events.

III. PHOTO/VIDEO RELEASE

The undersigned irrevocably consent to being photographed or being recorded by means of video or audio tape recording by the Organizers, or a designated representative of the Organizers. These photographs and/or recordings can be used, without compensation to the undersigned and/or the Delegate, in any public display, publication, or media, or website, or in any manner or form, and at any time by the Organizers in promotion of the mission to promote the theatrical arts and have theatre arts recognized in all phases of education. The undersigned releases the Organizers, their employees, agents, representatives, associates, Board of Directors members, and consultants from any liability arising from the use of such photographic, video, and/or other materials.

IV. SOCIAL MEDIA & SOLICITATION POLICY

Social Media: Delegates may not use social media sites to publish disparaging or harassing remarks about Texas Thespian members. Delegates who choose to post editorial content to websites or other forms of online media must ensure that their submission does not reflect poorly upon Texas Thespians. Consequences for actions deemed inappropriate: 1) Remove or edit comments at any time, whether or not they violate this Policy. 2) Ban future posts from people who repeatedly violate this Policy. We may affect such bands by refusing posts from specific email addresses or IP addresses, or through other means as necessary. 3) Disciplinary actions that are decided on by the Texas Thespians Board of Directors. 4) Removal from Festival. Solicitation: Selling, soliciting, or fundraising of any kind is strictly prohibited. Delegates will be removed from the Festival if they are found to be in violation of this policy.

V. AUTHORIZATION

I consent to the use and disclosure of protected health information by the closest medical facility for the purpose of analyzing, diagnosing, and providing treatment to the above-stated delegate, obtaining payment for health care services rendered or to be rendered, or conducting health care operations. A copy of this consent is as valid as the original. I authorize my insurance benefits to be paid directly to the closest medical facility. I assume full responsibility for and agree to pay for all services rendered or to be rendered. I understand that I have a right to receive a copy of this consent upon request and to revoke this consent in writing at any time, except to the extent that the closest medical facility has acted in reliance on it. This authorization is valid for one year from the date signed, through the policy term, and for the required period to process the claims.

VI. Background Check (Adult Delegate Only)

I understand my ability to participate in any program involving children as a Texas Thespian employee or volunteer may be contingent on the receipt and evaluation of my Background Check. Failure to provide consent will result in the denial of or termination of my participation in any program involving children. I understand that Texas Thespians may obtain follow-up Background Checks at any time during my participation in such programs, to the extent permitted by law, unless I revoke this consent in writing. I understand that revocation of this consent may result in the immediate termination of my participation. I understand that any information obtained from a Background Check may be considered in the course of any current or future engagement, including employment, with Texas Thespians. I understand that if the Background Check indicates that an outstanding warrant has been issued against me, Texas Thespians will share that information with appropriate law enforcement agencies. I have read and understand all the information above, and by my signature, consent to and hereby grant authorization to obtain and release the background check reports described above to Texas Thespians within the terms of this Statement.

The Delegate or the Delegate's parent and/or legal guardian has read, understands, and agrees to be bound by the above provisions, as evidenced by their signature below:

Today's Date: April 9, 2026

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Parent or Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Relationship*
Phone*
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Date of Birth*
Date of Birth
Information

School Name: *

Troupe Number: *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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