Student's Name *

First Name

Last Name

In the event of a medical emergency, I authorize Arts10566 to seek medical attention for my child: *

Yes

I understand that my child will be provided with, at no cost to my family, all necessary materials to participate: *

Yes

I understand that my child is required to wear a mask at all times during in-person classes and that failure to do so and/or follow social distancing guidelines will result in my child's removal from the program. If I do not have a mask for my child, Arts10566 will provide one: *

Yes

I understand that my child's temperature will be taken when he/she arrives for in-person classes, and if his/her temperature is above 100 degrees, he/she will not be permitted to enter class: *

Yes

I give Arts10566 permission to take photographs and short videos of my child to be used for promotional purposes (i.e. social media & website postings, grant applications & newspaper articles): *

Yes

I hereby authorize my child to participate in Art10566's Mural Project Class. I certify that my child is in good health and able to follow all social distancing guidelines, including wearing a mask. I release Arts10566 and its agents, servants and employees from any liability for personal injuries or property damages sustained by my child in connection with such participation: *

Yes