Nurture Your Creative Heart
Please enter your home / mailing address
Does your child have any allergies or health conditions?
Emergency Contact 1 - Name & Phone Numbers
Emergency Contact 2 - Name & Phone Number
Parent Phone Number
Adults Authorized for Pick-up (listed with driver's license numbers)
Hospital Preference in Case of Emergency
Child's Grade in 2015 - 2016 School Year
Please read carefully.
Myself / my child, I knowingly and voluntarily assume all risks involved in my participation at camp, and do hereby release the The Austin Artery from any and all liability, damages, costs and expenses arising out of or relating to bodily or psychological injury, loss of life or personal property that may occur as a result of participating in this program. I have read and understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of this and all future programs I participate in.
I do give my child permission to participate in Summer Camp 2015 with the Austin Artery at Four Seasons Community School.
I do not give my child permission to participate in Summer Camp 2015 with the Austin Artery at Four Seasons Community School.
Waiver for Medical Treatment (Required): In the event that my child requires emergency medical treatment and I cannot be reached, I hereby authorize the Austin Artery and/or Four Season Community School staff to make arrangements to transport my child to the physician, hospital or clinic that I have designated or the nearest hospital / emergency medical facility. I give my consent for any and all necessary medical care treatment for my child during this time
I give my permission
I do not give my permission
Waiver for Photo/Video Release
Waiver for Photo/Video Release (Optional): I give my consent for any photos or videos taken of my child involved in Austin Artery programs to be used for Austin Artery promotions, trainings or displays.