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Students entered below will be added to your family's account
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WAIVER, RELEASE PAYMENT AUTHORIZATION
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ASSUMPTION OF RISK
I hereby authorize/consent myself, my child(ren) and/or my child(ren)'s caregiver to participate in Small Hands Big Art activities, except as noted in the "Comments" section below.
I hereby acknowledge, agree, and accept the risk of injury inherent in any physical activity or program, including particularly, the activities offered by Small Hands Big Art. Such risks may include but are not limited to falling, bumping, risks from abrasions, scrapes, cuts, broken, sprained or bruised limbs, choking, injury to eyes, consumption or inhalation of paint or other media, allergic reactions, as well as risks from the actions or omissions of others.
Small Hands Big Art exercises reasonable care and precautions to minimize the risk of food-related allergic reactions during summer or holiday camp snack time, including implementing, communicating, & enforcing strict no-nut snack policies; however, Small Hands Big Art does not in any way ensure that the risks are completely mitigated, nor does it assume liability for any food-related allergic reactions. We require all children who are prescribed an epi-pen, inhaler, diabetic monitor or other medical device carry it with them at all times while on the premises. Parents/Guardians assume full responsibility for their child's allergies and other medical conditions.
RELEASE OF LIABILITY
I hereby release, discharge, indemnify and hold harmless Small Hands Big Art, its owners, members, managers, instructors, affiliates, agents, employees, successors and assigns, from any and all injuries, illnesses, medical conditions, medical care, death, damages, claims, liabilities, expenses or judgments, including attorneys' fees and court costs resulting from my, my child(ren)'s, or my child(ren)'s caregiver's participation in a program or presence on Small Hands Big Art's premises or other location where Small Hands Big Art may conduct art instruction, except as such may arise out of Small Hands Big Art's gross negligence.
MEDICAL EMERGENCIES
I grant permission for the staff at Small Hands Big Art to take any and all necessary steps to obtain emergency medical care for my child(ren), if warranted in their sole discretion, and agree that any expenses associated with any medical care will be my responsibility. In all cases of emergency, the child's welfare will be the primary focus; however, every reasonable attempt will be made to immediately reach the Parent/Guardian or designated caregiver. These steps may include, but are not limited to, the following:
• Administering first aid / CPR
• Calling an ambulance or paramedics
• Administration of reasonable medical care as determined by medical personnel in their professional judgment, including, but not limited to, surgery and administration of anesthesia
PHOTO, VIDEO & ARTWORK RELEASE
I hereby assign and release to Small Hands Big Art, its owners & affiliates, all rights to reproduce for the purpose of publication in any manner, photos, video, film, and/or sound recordings of me or my child(red). Small Hands Big Art may publish the name of any child in connection with the publication of any photo, video, sound or artwork without such child's parent (or guardian's) express consent. In addition, I agree that Small Hands Big Art shall have a fully-paid, perpetual license to use photographs, copies or reproductions of any work of art produced in its studio by me or my child(ren).
PAYMENT AUTHORIZATION
I understand that payment is due at the time of enrollment, and give permission to Small Hands Big Art to charge my card for applicable tuition and registration fees for the program(s) in which I enroll.
I've read the above and agree.
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Card Expiration Month: * |
Exp Year: *
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City:
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State:
Zip:*
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