The person(s) listed will be used as emergency contacts for the listed City Academy student. Should the school need to contact the family of a student in instances of emergency, the information provided on this form would be used to make necessary contacts. City Academy elects to make first attempt to the student’s parent(s)/guardian(s), then continue in sequential order until someone on this form has been notified of the emergency. By checking the Authorized Sign-In/Sign-Out, you are also giving the person(s) listed on this form authorization to sign the listed City Academy student in at the beginning of the school day, and sign them out at the end of a school day. By signing, you also understand that the student listed will not be allowed to be signed in or out without an authorized signature.

This should be a parent/guardian

I understand that audio and/or video recordings and photographs may be made of me (the parent or guardian) and my child/ren (student/s at City Academy) and my or my child/ren’s name, likeness, image, voice, statements (in audio or print form), appearance, and biographical information (the “Images and Sounds”) during my participation one or more programs with City Academy. I grant to City Academy and their agents, licensees and assigns (collectively “Releasees”), the perpetual, royalty-free, worldwide rights to make, use, publish, perform, copy, alter, distribute, register as a copyright, and make and license derivative works from, the Images and Sounds, in any media, now known or hereafter developed, for promotional or any other lawful purpose. I also authorize the use of any printed material in connection with the Images and Sounds. I waive any right to inspect or approve the finished materials, or the promotional or other copy that may be used in connection with the Images and Sounds, or any use to which they may be applied. I release, discharge, and agree to hold harmless Releasees from any liability arising out of any use of the Images and Sounds, and from any claims sounding in defamation, right of privacy, right of publicity, misappropriation, or similar proprietary right. I have the authority to grant Releasees the rights granted herein. I have read the above Release prior to its execution and understand the contents hereof. I grant all rights above in consideration of permission to participate in one or more programs with City Academy and other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge. I acknowledge that I will not receive any further consideration for any of the rights granted under this Release.

In anticipation of a year of exciting field trips, we are asking if you would sign the general permission form below. This blanket permission slip will suffice as your permission for all field trips during the 2022-2023 school year. Overnight field trips will require a separate permission form. Detailed trip information, including destination, date, time of departure, time of return, purpose and supervision, will be provided in writing to the parent/legal guardian at least one (1) week prior to each field trip in the series by school personnel. If there is a specific trip that you do not wish your child to participate in, you may elect to opt-out by notifying your child’s teacher or principal in writing. If you wish to provide permission for your child to participate in these activities, please sign this form of consent. As parent/legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student. I understand that these activities will take place away from City Academy and that my child will be under the supervision of the designated school employee(s). If any emergency medical procedures or treatment are required by my child during the trip, I consent to the designated supervising school employee(s) to provide, arrange for and/or consent to the necessary procedures or treatment.

All first-sixth grade students will receive a violin during the 2022-2023 school year. In order to receive a violin, you and your child must read and sign the following agreement. I agree to maintain the instrument during the academic year and return it to Mrs. Reycraft in June at the end of the school year. I understand that this means that the INSTRUMENT MUST . . .  Be kept in an area of regulated temperature – not too hot, cold or humid.  Never be stored in the car, trunk or garage  Never be outside or in the sun  Never be placed by a heating or A/C duct  Never be left in a sun room  Never get wet  Never used as a toy  Never used by any other children in the house other than the one on this contract I understand that if the instrument is broken, damaged, lost, that the replacement or repair cost is my responsibility. I understand that the replacement cost could exceed $200.00 (per violin) and $100.00 for the bow and $50.00 for the case. City Academy has a long standing relationship with Top Notch Violins & St. Louis Strings Violin Shop. It is required that you choose one of these violin shops should your child’s violin need repair. Please DO NOT attempt to repair your violin or accessories by yourself, this may result in entire instrument replacement.