Child's Name *

First Name

Last Name

Guardian's Name *

First Name

Last Name

DOB *

Minimum age is 4 years old

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Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Alternate Contact Name *

First Name

Last Name

Alternate Contact Phone *

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Primary Care Physician *

First Name

Last Name

Primary Care Physician Phone *

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I hearby give permission for my child to attend and participate in CAS Kids Summer program. Per CAS policy, guardians must children in and out at the beginning and end of every session. *

Agree

Liability Release *

In consideration of Catskill Art Society (CAS) allowing the Participant to participate in CAS Kids, I, the undersigned, do hereby release, forever discharge and agree to hold harmless CAS, its director, board of directors, employees, volunteers and teachers (collectively herein the “CAS”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in activities and classes at CAS Kids. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said CAS for any liability sustained by said CAS as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.

Agree

Medical Release *

I recognize there is neither a nurse, doctor or any trained medical professional on the premises and CAS employees, volunteers, teachers are not responsible for administering any medication. All medication administered on CAS premises, must be administered by the child’s guardian. I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.

Agree

Child's Name *

First Name

Last Name

Guardian's Name *

First Name

Last Name

DOB *

Minimum age is 13 years old

MM

DD

YYYY

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Alternate Contact Name *

First Name

Last Name

Alternate Contact Phone *

(###)

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Primary Care Physician *

First Name

Last Name

Primary Care Physician Phone *

(###)

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I hearby give permission for my child to attend and participate in CAS Kids Summer program. Per CAS policy, guardians must children in and out at the beginning and end of every session. *

Agree

I hearby give CAS and their agents permission to use photographic, portraits, pictures, digital images or videos of my child, or in which my child may be included, including but not limited to use in any CAS publication or on website and social media. *

Agree

Disagree