Catalyst Creative Arts After School Pottery Program 2020

Registration & Release Form

PARTICIPANT(S) INFORMATION

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PARENT/GUARDIAN INFORMATION
PERSON(S) AUTHORIZED TO PICK UP PARTICIPANT

In case of emergency and in the event that none of the emergency contacts can be reached, CATALYST CREATIVE ARTS will need signed authorization (below) to seek medical assistance for your child. I give permission to the CATALYST CREATIVE ARTS, its employees and designated representatives, to use whatever emergency (e.g., first aid, disaster evacuation) measures are judged necessary by them for the care and protection of my child while under supervision of the CATALYST CREATIVE ARTS. In case of medical emergency, I understand that my child will be transported to appropriate medical facilities by a local emergency unit for treatment if the local emergency resource (police or paramedics) deems it necessary. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child's physician and/ or other emergency contacts acting on the parents' behalf.

I, the undersigned, grant Catalyst Creative, LLC d/b/a CATALYST CREATIVE ARTS, permission to use any pictures taken in public view of myself individually, my child (participant(s) listed above), or any in which I (or the participant(s)) appear in whole or in part during After School Pottery Program. I understand that these pictures may be reproduced in print and electronic media specifically to promote CATALYST CREATIVE ARTS. I waive any right to inspect or approve said pictures, or any captions or accompanying texts that may be used in connection with them, or to approve the use to which said materials may be applied.

Typing your name into the input field above serves as your signature.