Mindful Movement Summer Camp 2024

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Event Timing: May 28, 2024 to August 16, 2024
Event Address: Art Cellar Houston, 1809 Eldridge Parkway, Suite 210, Houston, Texas 77077
Contact us at (832) 596-7983 or Email artcellarhouston@gmail.com

Email *

Child's Name *

Child #2 Name *

Parent Name *

Contact Phone *

In Case of Emergency Contact: *

Alternate Pick 1 Up Name & Phone

Alternate Pick Up 2 Name & Phone
*

Which week(s) will your chld attend? *

Wk 1: May 28th to 31st (Kawaii)

Wk 2: June 3rd to 7th (San Rio)

Wk 3: Jun 10th to 14th (Star Wars)

Wk 4: Jun 17th to 21st (Around the World)

Wk 5: Jun 24th to 28th (Outer Space)

Wk 6: Jul 8th to 12th (Sea Creatures)

Wk 7: Jul 15th to 19th (Mythical Creatures)

Wk 8: Jul 22nd to 26th (Zoo Animals)

Wk 9: Jul 29th to 31st (Lego & Minecraft)

Wk 10: Aug 5th to 9th (Into the Future)

Wk 11: Aug 12th to 16th (Woodland Creatures)

Required

Allergies:

My child has allergies to the following foods, nuts, herbs, and/or spices. Please choose "None" if your child does not have any food allergies or list the items your child is allergic too under "Other".

None

Nuts

Vegan

Herbs

Gluten-free

Spices

Other:

Required

Liability Release Form

Assumption of Risk, the release of liability for personal injury, agreement to hold instructor harmless of fault. I (Parent or Legal Guardian Name) agree and consent to the following:

I understand it is my responsibility to advise the Art Cellar Houston Staff of any medical conditions, allergies, or any circumstance that would inhibit the Art Cellar Houston staff from teaching the class and the student participation in the above-mentioned art program.

I verify and affirm that my child has no medical condition that would prevent their participation in this program, nor will my child verbally or physically threaten any child or any member of our teaching staff at the Art Cellar of Houston studios. Children that are verbally or physically threatening to others, will be asked to leave immediately without refund.

I understand paint is toxic and will stain clothes, and therefore (on behalf of my child) agree to explain to my child not to consume the paint or put it on their clothing AND/OR their body.

I agree to assume full responsibility for any risks, injuries, or damages known or unknown that my child may inflict or incur as a result of participating in this art camp at The Art Cellar of Houston LLC. Any child inflicting threats and/or harm on any child and/or teacher will be removed from our program without refund. No exceptions.

I knowingly, voluntarily, and expressly waive any claim I may have against The Art Cellar of Houston, Sarah B. Lowe, and any other instructor imparting classes at the Art Cellar of Houston for the 2024 Mindful Movement Summer Camp for the months of May, June, July, and August for any injury or damages sustained as a result of participating in this program. I, my heirs, or representatives forever release, waive, discharge, and covenant not to sue Sarah B. Lowe and any other instructor imparting classes at the Art Cellar of Houston for any injury or death caused by negligence or other acts. I have read the above waiver and release of liability and fully understand its content. I voluntarily agree to the terms and conditions outlined above.

Required

Photo Consent:

We recognize the need to ensure the welfare and safety of all young people taking part in any activity associated with our organization. In accordance with our child protection policy, we will not permit photographs, videos, or other images of young people to be taken without the consent of the parents/carers and children. As your child will be taking part in the event specified above, we would like to ask for your consent to take photographs/ videos of the event or activity that may contain images of your child. It is likely that these images may be used as

• a record of the activity or the event.

• in a written evaluation of the event that will be viewed by the public.

• publicity material for further activities or events on leaflets/websites/ magazines.

• illustrations of the activities or events in published articles, artcellarhouston.com, or the company’s social media sites.

• future grant applications.

We will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform us immediately.

If you consent, please check the box below. If you do not consent, please add your child's name in the next section.

I consent to have my child photographed or recorded and posted on the Art Cellar of Houston’s social media and/or website pages.

I DO NOT consent to have my child (enter name below) photographed or recorded and posted on social media and/or the Art Cellar of Houston website.

The participant is not 18 years of age or older and I, provide consent as the parent or guardian of the participant. I have read, understood, and agree to the above outlined terms. Parent or Guardian, please electronically sign below to assume responsibility for the above terms.

A copy of your responses will be emailed to the address you provided.

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