Parental Consent For Art Camp

Child's Full Name & Age

Second Childs Full Name & Age

Parents full names

Cell Phone

Emergecy Full Name

Emergency's Cell Phone

Full Names of everyone that can pick up your child.

Preferred Hospital, Name of Doctor

Does your child have special instructions for medical treatment? If yes, please explain, including the medication your child is taking *

Does your child have any allergies?

Is there anything else we should know?

Please advise if there is anything else we need to be aware of, i.e., persons not authorized to pick up your child.

I give consent for photos taken during camp, that may include my child/children, be used to promote future Summer Camps. If you do not consent your child/chilren might still be in photos taken from behind that do not show their face.

Check to agree- I understand that my child will not be released to any person not previously listed above.

Check to agree- My child will not be released to any person who seems to be under the influence of drugs or alcohol.

Check to agree- I agree to text 916-439-7256 if I am going to be more than 15 minutes late picking up my child(ren) with an ETA

Check to Agree- We do not tolerate cursing, hitting, biting, or bullying of other children or staff. We are a private business and can refuse to service to any person.

IMPORTANT!- Type your signature here to agree to all statements and information.

Child's Birthday

Month

Day

Year