MASK PAINTING - AUG 11

Paul Drum Life Experience Project

Registration & Constent Form

The Paul Drum Life Experience Project provides instructions
for various activities for children ages 7–12.
All activities are supervised by adults and proper
safety conditions are carefully adhered to.

MASK PAINTING
Thursday, August 11th
9:45am-11:00am

PLEASE NOTE:
A Registration/Consent Form is required for EACH child attending.

Name (Child) *

First Name Last Name

Age *

Date of Birth *

Date

Name (Parent/Guardian) *

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone (Cell) *

Area Code Phone Number

Phone (Day)

Area Code Phone Number

Phone (Evening)

Area Code Phone Number

I receive texts from cell number *

YES NO

Email *

example@example.com

Preferred Contact Method

Home Phone Cell Phone Text Email

Family Doctor

Doctor's Phone

Area Code Phone Number

Emergency Contact (if different from above)

Name

First Name Last Name

Relationship to child

Phone Number

Area Code Phone Number

Acceptance of Child’s Participation Guidelines:
I understand my child is required to abide by a code of proper behavior, attentiveness and co-operation. I, too, agree to honor the commitment of attendance by respecting the program hours, giving 2 day notification if my child is unable to attend, being respectful of Project educators and volunteers, and supportive of the Paul Drum Life Experience Project’s mission.

I also authorize a Project designee to administer immediate or emergency medical treatment. If any unforeseen condition shall arise, calling on the judgment of the physician or the designee, I authorize the medical designee to do what is advisable provided an immediate effort is made to contact me. I will always be available by telephone for the period my child is attending this not for profit educational program.

Signed: *

Name serves as signature of consent

Date *

Use of Photographic Images
Throughout the course of the summer there are many occasions when photographs of participating children may be taken for use on our website, our social media and /or promotional materials. These tools allow the community to learn more about our program and allows us to highlight the children’s achievements and activities. Photos of large groups, or action photos where children are not identified, may be posted without parental permission.

As pursuant to law, we will not release any personally identifiable information without prior written consent from you as a parent or guardian.

Signing this form will be deemed as consent for the Paul Drum Life Experience Project to allow your child to be included in the above for the 2022 summer season.

Signed: *

Name serves as signature of consent

Date *

Enter the message as it's shown *