Participant Agreement

Mother, Father etc.
Complete Mailling Address
Mother, Father etc.

***Art, Photo, Web and Video Release Permission***
My child has my permission to participate in art shows and to have artwork displayed or printed.

My child may be photographed for print, Art House web page, Facebook, Instagram, videotaped and audio tape recorded. I understand that these materials would be used in public relations and/or in development programs for the Neighborhood Art House.

Children that will be attending the Neighborhood Art House are:
By January 1, 2019
Example: Daily Medications, etc.
Example: Daily Medications, etc.
Example: Daily Medication, etc.
Example: Daily Medications, etc.

Emergency Contacts If Parent/Guardian Cannot Be Reached

The Neighborhood Art House Participation Agreement

I, the parent/legal guardian of the registrant, a minor, agree to my son’s/daughter’s participation in the Neighborhood Art House. It is understood that participation in such activities has an inherent risk of injury to the registrant.

I, for myself, family members and the registrant, release and hold harmless the Neighborhood Art House, its employees and volunteers from any and all liability for injury to the registrant arising from participation in the Neighborhood Art House programs, and/or being transported to or from the same, which transportation I hereby authorize.

I give my full consent to the Neighborhood Art House and any medical professionals to administer whatever emergency medical treatment is deemed necessary for my son/daughter in the event of an unforeseen injury or illness. I acknowledge that my son/daughter has no known allergies or medical conditions except as noted above (If none, state NONE):


Parent/Guardian's Permission Regarding Medical Care

I, the undersigned parent/legal guardian, do hereby grant permission to any licensed physician to perform or provide necessary emergency medical care or aid to my son/daughter in connection with the Neighborhood Art House program. I am aware any and all costs associated with said care are my responsibility.

I, the undersigned parent/legal guardian, have read and understand all of the above. Subject to the above, I agree to the registrant/s participation in Neighborhood Art House activities for the period from June 24, 2019 to September 15, 2019.