Carnegie Picture Lab Class Permission and Waiver Form
Child’s Full Name__________________________ Age___________ Home phone_______________
Parent Name_____________________________ Work Phone_______________Cell phone_____________
Parent Name______________________________Work phone______________ Cell phone_____________
Emergency Contact Name______________________ Work phone____________ Cell phone_____________
Mailing Address___________________________________Email address___________________________
Allergies to food or art supplies? ________ If yes, please explain__________________________________
Other information that Carnegie Picture Lab should know about the child:
Name of Persons Authorized to pick-up Child from Carnegie Picture Lab
(Child will not be allowed to leave with any other person without written authorization from parent or guardian)
Photographs:Carnegie Picture Lab 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, oil pastels, pencils, drawing and painting in nature, walking. Carnegie Picture Lab takes all possible precautions to reduce risk and provide safe, healthy and enjoyable experiences. I warrant that my child is able to follow directions for all activities in this 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 Carnegie Picture Lab liable for any personal injury, property damage or loss of insurance. I agree to release and hold harmless Carnegie Picture Lab and its staff from all liability incurred as a result of my child’s participation in studio class and outdoor art-making and that these terms serve as a release or 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 CPL class.
Print Name (Parent/Guardian)_____________________________________________
Signature (Parent/Guardian)_________________________________ Date___________________