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ArtReach HQ Guardian Consent Waiver
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name
(Required)
First
Last
Must match photo ID which will be verified at pickup.
Email Address
(Required)
Email Address
Confirm Email Address
Phone
(Required)
Relationship to Student(s)
(Required)
Address
(Required)
Street Address
Address Line 2
City
State
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American Samoa
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District of Columbia
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ZIP Code
Additional Parent(s)/Guardian(s) attending workshop?
(Required)
Yes
No
2nd Parent/Guardian Name
(Required)
First
Last
Must match photo ID which will be verified at pickup.
Phone
(Required)
Relationship to Student(s)
(Required)
3rd Parent/Guardian Name
First
Last
Must match photo ID which will be verified at pickup.
Phone
Relationship to Student(s)
EMERGENCY CONTACT INFORMATION
Emergency Contact Name
(Required)
First
Last
Must match photo ID which will be verified at pickup.
Phone
(Required)
Relationship to Student(s)
(Required)
STUDENT INFORMATION
Student Name
(Required)
First
Last
Age
(Required)
Birthdate
(Required)
MM slash DD slash YYYY
Add more Students?
(Required)
Yes
No
2nd Student Name
(Required)
First
Last
Age
(Required)
Birthdate
(Required)
MM slash DD slash YYYY
3rd Student Name
First
Last
Age
Birthdate
MM slash DD slash YYYY
4th Student Name
First
Last
Age
Birthdate
MM slash DD slash YYYY
5th Student Name
First
Last
Age
Birthdate
MM slash DD slash YYYY
GUARDIAN CONSENT, WAIVER OF LIABILITY, AND MEDIA RELEASE
As parent or legal guardian of the student(s), I agree to the following:
Engagement in Art Activities
(Required)
I confirm that the student is: able to participate and follow all directions and instructions by ArtReach Teaching Artists. I confirm that the student (ages 5+) is mature enough to attend a workshop without a legal guardian. I understand that if the student is unable to meet these expectations, I will attend the workshop with them. Disregarding studio rules and directions by ArtReach Teaching Artists and staff may result in immediate removal from the workshop. I understand that I am responsible for the transportation to and from the workshop for the student.
I agree to the above terms and conditions.
Risk Assumption
(Required)
I acknowledge the risks involved in participation in workshop activities and various visual arts materials and tools, and am permitting the student to attend and participate in ArtReach art workshops knowing these risks and potential consequences such as personal injury or loss of property. I understand that the studio space where the workshops are held will host other participants of all ages and that ArtReach is not responsible for any loss or damage of property to the student’s personal items. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I and the participant(s) may be exposed to or infected by COVID-19 and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at ArtReach may result from the actions, omissions, or negligence of myself and others, including, but not limited to, ArtReach employees and other participants.
I agree to the above terms and conditions.
Liability Waiver and Release
(Required)
I hereby knowingly waive and release any and all known or unknown claim against ArtReach, its employees, board members, or other directly affiliated members, whether professionally or personally, including without limitation any actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees and costs, incurred due to claims brought by any third party as a result of or arising out of the participant’s involvement in activities and to reimburse ArtReach for any such costs, expenses and fees as they are incurred. Should any such claim, suit, cost, expense, or liability arise from the participant’s involvement in ArtReach programs, the undersigned shall defend, indemnify, and hold ArtReach harmless from any potential liability caused, related to, or arising from the participant’s involvement and/or conduct.
I agree to the above terms and conditions.
Media/Photo Release
(Required)
I permit ArtReach to use photos/videos of the student for potential promotional materials on social media, email campaigns, grant reports, and marketing collateral.
Yes
No
Parent/Guardian Certification
(Required)
I hereby certify that I am the parent or legal guardian of the above participant(s), and I have authority to waive rights on behalf of the minor participant(s). I have read and I understand all of the provisions of this document and the risks of activities.
I agree to the above terms and conditions.
Is there anything else you would like to share with us about your student(s)?
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