Allergies
If participant has allergies describe all allergens, all allergic reactions and any medication (i.e. epipen, benadryl) that need to be administered.
Physical / Medical Conditions
Does the participant have any physical or medical conditions that could result in an emergency or preclude them from engaging in certain activities?
Medications
Please list all medications (including over-the-counter or nonprescription drugs) taken routinely.
Social Emotional Well-being
Is there anything else our artists need to know about the participant that would help us provide the best experience for them?
INDEMNIFICTION and RELEASE of CLAIM AGREEMENT* I have carefully read this agreement and understand it to be a release of all claims and causes of action for myself and/or my children's injury, illness or death and damage to my property that occurs while participating in the described program.
In Consideration of myself and/or the children I am now registering being allowed to participate at the Holter Museum of Art, I the undersigned, on my own behalf and on the behalf of my children, acknowledge, appreciate and agree to the following conditions:
1) I represent that I am the parent or legal guardian of the children I am now registering.
2) I agree that I and/or my children shall comply with all stated and customary terms, posted safety signs, rules and verbal instructions as conditions for participating in Holter Museum of Art's activities.
3) I am aware that there are inherent risks associated with participation in Holter activities and I, on behalf of myself and on the behalf of the children I am registering today, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of staff and other participants. I hereby allow my children to participate in Holter activities. I do hereby release, discharge, and hold harmlessHolter Museum of Art, its employees, volunteers, agents and assigns from any and all claims, demands, rights and/or causes of action whatsoever kind or nature arising from or by any reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, loss and/or damage to property, and the consequences thereof resulting or which may result from myself and/or my children participating in the camp activities.
4) I understand that all participants are expected to follow directions and be safe while atthe Holter. It is particularly important that participants stay with the group to ensure they are being supervised. If my children are creating conditions that may harm themselves or another participant, the Holter reserves the right to require my presence during activities. If behaving in a way that is dangerous to self or others and in instances of extreme or repeatedly disobeying staff directions, the Holter Museum of Art reserves the right to dismiss myself and/or my children from the rest of a session.
5) I give my consent for the personnel of Holter Museum of Art to secure emergency medical care and/or first-aid treatment, for myself and/or my children named above, as emergency conditions might require while under supervision of said personnel. I authorize the Holter staff or their agents to arrange transport of myself and/or my children to a healthcare facility for emergency services as needed.
8) I hereby acknowledge that the Holter Museum of Art will assume that either parent-guardian of the children may pick up the children at any time during the program unless there is pertinent court documentation on file that indicates otherwise.
9) If my children have allergies or other medical conditions and I expect that it may be necessary for the Holter Museum of Art to give my children medicine during the session, I will indicate this in the Health History Questionnaire above and send the medicine to camp with my children. I will provide a list of the medications with detailed instructions on administration of the listed medication.
10) I hereby grant to the Holter Museum of Art the right to use and publish photographs of myself and/or my children, or in which we may be included, for website design, editorial, trade, merchandising display and advertising for the purpose of promoting the activities of the Holter Museum of Art; to alter the same without restriction and to copyright the same. I hereby release the Holter Museum of Art from all claims and liability relating to said photographs.