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ARTS & MINDS Kids Participant Waiver

Waiver

I, the undersigned, parent or guardian, acknowledge and fully understand that my child will be engaging in physical activities that may involve some risk of injury. In the case where my child has an injury, sickness or anything else that may be affected by physical activity, I have consulted with a physician to ensure my child can take the class. I recognize that it is my responsibility to notify the Instructor of any serious illness or injury before every class.

I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by my child which might incur as a result or participating in this program and discharge and hold harmless Arts & Minds, LLC, its owner, and agents from any claim, cause of action or liability for damages arising from any personal injury to my child or other persons or property caused by myself or my child’s participation in the Arts & Minds Movement and Creative Arts Program.

Date: December 11, 2018

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information

School:

Grade:

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First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

School:

Grade:

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Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

School:

Grade:

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Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

School:

Grade:

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Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

School:

Grade:

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Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

School:

Grade:

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Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

School:

Grade:

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Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

School:

Grade:

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Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

School:

Grade:

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Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

School:

Grade:

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Parent or Guardian's Email Address

Email*

Confirm Email*
Interested in more Movement + Creative Arts for your kid?
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Additional Information

Best contact email/phone during class? We will text you FIRST!! 

Best contact email/phone for details about class (including scheduling updates)? 

WHO IS AUTHORIZED TO PICK UP KIDDO? please list all. If you need to add to the list, email us!

Are videos, pictures, and social media posts ok of your kiddo?*

Any other info you would like for us to know? (Sunscreen application, food allergies, emotional/sensory support needed)

Each of our classes include Movement and Creative Arts. Your kiddos will engage in any combination of dance/fitness/yoga AND drama/music/creative writing/art throughout their time with us. Please dress your kids in whatever they like to play and create in. We may get a little messy at times, but we'll give you a heads up. Anything goes! If you have questions about our curriculum, programming, performances, etc - email us: info@artsandmindskids.com 

Click to customize question*
No
Yes
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

School:

Grade:

Click to customize date box label
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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