Drop-Off Form at the Everson

Come see us for a night out this Thursday, December 15th for holiday themed programs! Adult guests can pre-register to drop-off their kiddos (Ages 7+ only) with our amazing instructors for winter themed activities and then explore the museum and all it has to offer for the night.


Please note, guardians must fill out a registration form to drop off kids. Only Ages 7+ are allowed. Drop-off will only last two hours from 6-8pm. Everson has a capacity 20 kids maximum for the drop-off. As policy it is first registered first served. *You MUST fill out a separate form for each child dropped off. 

Call the Everson's Learning and Engagement Department with any questions or concerns at 315-474-6064 x 314

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Email: *
Students Name First and Last  *
Students age  *
Students pronouns 
Guardian Information 
Guardian Name #1 (first and last) *
Guardian #1 Relationship to the Student 
Guardian #1 Phone Number
*
Guardian #1 Address
Guardian Name #2 (first and last)
Guardian #2 Relationship to the Student 
Guardian #2 Phone Number
Guardian #2 Address
Camper Pick-Up Authorization
Please note that any persons, including guardians, will be asked to show proof of identification when picking up a camper. Please be ready with your photo ID. Thank you for your cooperation.
Authorized Pick-Up #1 First and Last Name
*
Authorized Pick-Up #1 Phone Number
*
Authorized Pick-Up #2 First and Last Name
Authorized Pick-Up #2 Phone Number
Student Health Information
If student has an allergy or medication, please fill out and return the Medical Authorization Form (hyperlink), and/or the Allergy Information Form (hyperlink). Both forms are an editable PDF. You download them, type in the information, save the documents, and email them to education@everson.org 
Emergency Contact First and Last Name
*
Emergency Contact Relationship to Student
Emergency Contact Address
Emergency Contact Phone Number
*
Does the student have a physical or developmental disability? If not, please leave blank.
If the student has a physical or developmental disability, please tell us how the Everson can help accommodate the student.
Does the student have any allergies? If not, please leave blank.
Does the student take any medications? If not, please leave blank. If so, please list the name of the medications and their instructions. A Medical Label Form and Medication Dispensing Information/Waiver Form will be distributed to guardians at a later date in addition to further instructions.
Is there anything else you'd like us to know about the student?
Participant Agreement, Release & Assumption of Risk
PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK.


Because participation in certain classes may be dangerous, EMA requires all participants to assume all risk. In consideration of the services of EMA, their owners, agents, officers, contractors, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge EMA, on behalf of myself, my parents, my spouse, my children, my heirs, assigns, personal representatives and estate as follows:

I acknowledge that my participation in various disciplines entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death or damage to me, to property, or to third parties. I understand that such risks cannot be completely eliminated. The risks include, among other things: bites, slips and falls; falling from equipment; pinches, scrapes, twists and jolts that could result in puncture, scratches, bruises, sprains, lacerations, fractures, concussions, or even more severe life threatening hazards; strains, cuts, bruises, muscle soreness, musculoskeletal injuries including head, neck, and back; injuries to internal organs, the negligence of other people; my own physical condition; and the risk of emotional and psychological injuries or physical damage associated with any activities.

In case of any emergency, I consent and hereby give my permission granting EMA the authority to obtain medical assistance and treatment as they deem necessary. I give my express permission and consent for medical treatment to be administered should illness or injury occur while in attendance at or while participating in any activity associated with EMA and to do so WITHOUT HAVING TO WAIT UNTIL I AM CONTACTED. I understand that neither EMA, its owners, officers, agents, contractors, employees or volunteers shall be responsible for any medical expenses incurred on behalf of the participant, and that I am responsible for all payments of medical expenses so incurred. I agree to reimburse EMA for any cost it may incur to provide medical assistance and treatment. Furthermore, EMA contractors and employees have difficult jobs to perform. They seek safety, but they are not infallible. They may be unaware of a participant’s fitness or abilities. They may misjudge the environmental conditions. They may give incomplete warnings or instructions, and the equipment being used might malfunction.

I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless EMA from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of EMA’s equipment or facilities, including any such claims which allege negligent acts or omissions of EMA. Should EMA or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. I certify that I have adequate INSURANCE to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of any and all claims, actions, demands or rights to monetary judgments whatsoever arising from any and all injury or physical harm which may arise from the rendering of such judgments, including specifically those that may arise out of, or be occasioned by, tis officers, agents, employees, contractors or volunteers involved in the rendering of such judgments. By checking the box below, I Hereby Release, Waive, Discharge and Covenant not to sue EMA and any of their owners, agents, officers, contractors, employees, and all other persons or entities acting in any capacity on their behalf for all loss or damage and any claim or demands therefore, on account of injury to the person or property or resulting in death of the participant, whether caused by the negligence of EMA or otherwise while the participant is upon the premises of EMA and/or a participant in EMA classes.
By printing name (Guardian) here you agree to the Participant Agreement, Release & Assumption of Risk.
*
Consent to Photograph, Video, and Record Audio of Student  Untitled Title

I hereby consent that I give permission to the Everson Museum of Art to photograph, film, interview, or quote me or my child/dependent and to share these materials on the Everson's public platforms (e.g. social media, website, and Everson publications, such as bulletins, brochures and postcards, films or other media content). I grant the Everson Museum of Art the right to edit, use, and re-use any media content that is generated by my participation in any Everson class. I hereby release the Everson Museum, its employees or agents of any liability in connection with the above listed media usage.
By printing name (Guardian)  here you agree to the Consent to Photograph, Video, and Record Audio of Student. If you do not agree, please leave blank.
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