One-On-One Art Session Consent Form
General Consent Form
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Email *
Full Name of Participant:
*
Age:
 *
Parent/Guardian Name:
Contact Phone Number:
 *
Emergency Contact Name and Phone Number:
*
Any known medical conditions or allergies:
*
Current medications being taken:
*
Any physical restrictions or limitations:
*
Allergy information (food, insect bites, etc.):
*
Do you consent to your child participating in walking, hiking and nature walk activities and transportation to and from the agreed drop-off location?
*
Required
Are there any concerns or restrictions regarding your child's participation in walking activities?
*
I give permission for my child to participate in all       activities from agreed locations around Prescott as part of the one-on-one art session.
*
In consideration for allowing my child to participate in the walking activities described above, I hereby release, waive, discharge, and covenant not to sue the organizers, staff, or volunteers of the summer camp program for any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child while participating in such activities.
*
Required
I understand that walking activities involve certain risks, including but not limited to trip hazards, uneven terrain, and encounters with vehicles or pedestrians, and I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by my child as a result of participating in such activities.
*
Required
Parent/Guardian Digital Signature:
*
Date
 *
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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