KIDS Information & Release Form

KIDS SUMMER ART CAMP Medical Information & Release Form

Each camper (aka - student, child) must have a contact form with Emergency Information received by the start of the camp. You can either complete the below form or request one via email at paintnwithfriends@outlook.com.

* Indicates required field

Child's Name *

First

Last

Child's Age *

Parent/Guardian's Name *

First

Last

Phone Number *

Email *

Name *

First

Last

Phone Number *

Email *

EMERGENCY CONTACT INFO

ALTERNATE EMERGENCY CONTACTS IF PARENT/GUARDIAN CANNOT BE REACHED

Name *

First

Last

Relationship to Child *

Phone Number *

Parents/Guardians are required to sign in and sign out all students *

I understand and accept

Medical Information

Please note any special concerns of which we should be aware (allergies, asthma, medical conditions, special needs, recent/current illness, or injury, medications*, etc.)

Your Answer *

Do these concerns require any additional accommodations? If yes, please explain.

Your Answer: *

**Paint'n With Friends will only administer emergency medications indicated by parents/guardians below. Parents/guardians are responsible for administering any other medications needed during camp hours.
If your child requires emergency medication such as an EpiPen, inhaler, etc. please ensure that your child brings it to camp, and that our staff has complete instructions on how and when to administer if necessary.

Please list any emergency medication your child may need:

Your Answer: *

Liability Waiver

I, individually or as parent and/or guardian of the minor child enrolling in a Paint'n With Friends Kids Summer Art Camp hereby acknowledge the following notices and grant to Paint'n With Friends, the following release from liability:

Liability: I understand that I, (the student) or my minor child (the student) will be completing projects that may use equipment when used improperly could cause bodily harm. Students will receive specific safety instructions from the teacher prior to using said equipment. Students will be expected to follow all safety procedures identified, demonstrated, and reviewed by the teacher. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by myself/my child which might incur as a result of participating in this program and discharge and hold harmless Paint’n With Friends Art Studio from any claim, cause of action or liability for damages arising from any personal injury to me/my child or other persons or property caused by my participation in the Paint’n With Friends Art Studio class.

Medical Release: I realize it is my responsibility to inform the Paint’n With Friends Art Studio of any medical illnesses, allergies, or physical limitations that might inhibit myself or my child from participating in activities at LUX Center for the Arts. If necessary, I understand that if I or my child become ill or injured, the staff of Paint’n With Friends Art Studio will direct me to be taken to a physician or hospital as the situation or occurrence may dictate. I hereby authorize emergency medical treatment for the registered participant in the event of any illness or injury sustained during participation in the Paint’n With Friends Art Studio class. I acknowledge that if I or my child receives professional medical and/or related services due to an injury, I am obligated to pay for such services and Paint’n With Friends Art Studio shall not be liable for payment of such services.

Personal Belongings: In addition, I understand that Paint’n With Friends Art Studio is not responsible and is held harmless for damage to clothing, jewelry or other personal articles. I understand that valuable items are brought to Paint’n With Friends Art Studio at my own risk.

Publicity Waiver: Unless informed in writing, the Paint’n With Friends Art Studio may use photographs of my child and their artwork for publicity and/or promotional materials, including on their website.

I agree not to hold Paint'n With Friends liable for any personal injury, property damage or loss of insurance. I agree to release and hold harmless Paint'n With Friends and Tomasa M. Brown from all liability incurred as a result of participation in this event and that these terms serve as a release for Tomasa M. Brown, volunteers, property owners and members of my family.

Waiver & Release of Liability *

I Accept

By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.

Person Signing Agreement *

First

Last

If you have any concerns regarding this form, please contact Tami Brown, Owner Paint'n With Friends.
email: paintnwithfriends@outlook.com or phone/text at 408-710-2327

Comments *

I agree to receiving marketing and promotional materials

Submit

KIDS SUMMER ART CAMP Medical Information & Release Form

EMERGENCY CONTACT INFO

Medical Information

Liability Waiver

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