KAC Youth (5-17 yrs) Emergency Form
Thank you for enrolling your child in a Krasl Art Center (KAC) program! Please fill out this Emergency Form before the first day of class.

Please fill out a separate form for each individual child, and answer all questions to the best of your ability.

If you have any questions or concerns, please reach out to Manager of Education, Nathan Margoni, at nmargoni@krasl.org
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Email *
Student Name (First & Last) *
Student Phone Number (If Applicable)
Student Pronouns (like she/he/they/other)  - https://www.mypronouns.org/
Photo Release: I give permission for my student to be photographed for use by Krasl Art Center (KAC). I grant KAC the right to use the photograph for the purpose of promotional advertising & documentation. Any questions or concerns may be sent to marketing@krasl.org. *
Text Message Alerts: Check this box to receive text notifications from Krasl Art Center regarding emergencies, closures, delays, and reminders. You may receive up to three messages per month. Messages and data rates may apply. Reply STOP to end or HELP for help. *
Guardian Name(s)
Guardian Phone Number(s) - Listed in same order as names.
Additional Emergency Contact(s) Name(s) - Individuals who are allowed to pick-up your student.
Emergency Contact Phone Number(s) - Listed in same order as names.
PLEASE NOTE: Any individual picking up or dropping off a student is required to have Photo ID available upon request.
We pay close attention to each student's social/emotional and general needs. Does your student have any allergies, medicals needs, or anything else we need to know? Please describe:
Emergency Treatment Release: In the event of a serious illness, accident, or injury that would require medical attention, 911 will be called and the student may be taken to the nearest emergency center. If necessary, an Emergency Medical Staff or a First Aid/CPR trained KAC Staff Person will take care of the student.
Medication Dispense Release: I authorize KAC's Education Administrative Staff to hold and dispense medication to my student.
Sign-In & Sign-Out Signature Release: Guardians are required to sign in and out of class for students age 13 and under, unless there are special circumstances.  Please explain special circumstances in "other" if necessary.
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