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This Addendum extends the current General Liability Release and Parental Permission with Medical Consent by incorporating the following list


1. Participating in the Intensive Piano Summer Camp at Bellevue Academy of Arts & Music and Northwest Pianos from July 31, 2023 to August 4, 2023.

2. Visits to and activities within parks, including but not limited to Bellevue Downtown Park, Medina Park, Medina Beach Park, Meydenbauer Bay Park, Botanical Garden, and Hidden Valley Park.

3. Consumption of food or beverages, or any related activities at various venues, including but not limited to: Molly Moon's Ice Cream, Sandwich House TRES, Dough Zone Dumpling House, Mox Boarding House, Panera Bread, Domino's Pizza, Southgate Mart, Dickey's Barbeque Pit, and Ezell's Famous Chicken.

In the event of an accident or illness during the child's participation in these activities, I give my consent for emergency medical treatment by qualified medical personnel, and I authorize representatives of the Organization to arrange for such treatment. I understand that the Organization is not responsible for medical expenses incurred because of the child's participation in these activities.

I represent that there are no health-related reasons or problems which preclude or restrict the child's participation in this activity, and that I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from the child's participation in the activity.


TRANSPORTATION AGREEMENT

I understand and acknowledge that the child's participation in the "Intensive Piano Summer Camp" may require transportation between various locations and venues related to the activities of the camp. This transportation will be provided by Bellevue Academy of Arts & Music's school van. By signing this agreement, I hereby consent to such transportation arrangements made by the Organization, and I understand that the Organization is not responsible for any injury, loss, or damage that may occur during the transportation process.


I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, MEDICAL WAIVER, AND TRANSPORTATION AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

First Student Name

First Name*

Last Name*
First Student Date of Birth*
First Student Signature*
Second Student Name

First Name*

Last Name*
Second Student Date of Birth*
Third Student Name

First Name*

Last Name*
Third Student Date of Birth*
Fourth Student Name

First Name*

Last Name*
Fourth Student Date of Birth*
Fifth Student Name

First Name*

Last Name*
Fifth Student Date of Birth*
Sixth Student Name

First Name*

Last Name*
Sixth Student Date of Birth*
Seventh Student Name

First Name*

Last Name*
Seventh Student Date of Birth*
Eighth Student Name

First Name*

Last Name*
Eighth Student Date of Birth*
Ninth Student Name

First Name*

Last Name*
Ninth Student Date of Birth*
Tenth Student Name

First Name*

Last Name*
Tenth Student Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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*
Parent or Guardian's Date of Birth*
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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