Dragonfly Art Studio Permission And Waiver Form printable pdf download

Dragonfly Art Studio Permission and Waiver Form

Child’s Full Name _________________________________ Age ________ Home Phone ________________

Parent Name _______________________ Work Phone _________________ Cell Phone ________________

Emergency Contact Name ___________________________________________ Phone ___________________

Mailing Address ________________________________ Email Address ____________________________

Allergies to food or art supplies?_______ If yes, please explain _______________________________________

Other Information that Dragonfly Art Studio should know about the child:

_____________________________________________________________________________

Names of Persons Authorized to pick-up Child from Dragonfly Art Studio

(Child will not be allowed to leave with any other person without written authorization from parent or guardian)

Name _______________________________________________ Relationship _______________________

DROP-OFF TIME is between 8:45am and 9:45am. Please, NO drop-offs earlier than 8:45 unless arranged.

PICK-UP TIME is between 3:30pm and 4pm. Please be ON TIME.

There will be a charge of $1 for every minute after 4:05pm. _____ (intital)

Photographs: Dragonfly Art Studio is granted permission to use group or individual photographs or photo images

taken during class for publicity or promotional purposes. Yes ____ No ____

Ability to engage in art activities and assumption of the risk:

Art studio activities, including but not limited to paints, glues, pastels, chalk pastels, pencils, wood/plaster tools, fiber

(yarn/fabric/papers), wax, plastic bags, batik dye, incense, plaster, drawing and sculpting in nature, hiking, and playing

outdoor games. Dragonfly Art Studio takes all possible precautions to reduce risk and provide safe, healthy, and en-

joyable experiences. I warrant that my child is able to follow directions for all activities in studio class. I acknowledge

that risks from participation in class activities exist and that I have allowed my child to attend art class knowing these

risks and their possible consequences including personal injury,

Waiver and Release of Liability

As a parent or guardian of my child, I agree that I will not hold Dragonfly Art Studio liable for any personal injury,

property damage or loss of insurance. I agree to release and hold harmless Dragonfly Art Studio and Oceanna

Holton from all liability incurred as a result of my child’s participation in studio class and that these terms serve as a

release for myself, volunteers, property owners and members of my family.

I am the parent/guardian of the child—who is under 18 years of age—that I am registering for Dragonfly Art Studio

classes.

Print Name (Parent/Guardian) ____________________________________________________

Signature (Parent/Guardian) ______________________________________ Date ___________

Dragonfly Art Studio Permission And Waiver Form