Emergency Contact #1

Emergency Contact #2 

Please list those people including in addition to parents/guardians who are permitted to pick up your child/children:

I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.

I understand that the creative kids teacher be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

I hereby give permission for my child to be photographed during the Creative Kids. I understand the photos will be used to share with families of our students and occasionally on our website or social media for promotional purposes. I understand that although my child's photograph may be taken, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Creative Kids and its affiliates.

The Creative Kids and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Childrens' photos and quotes may be used for publicity purposes. In case of an emergency. and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician

I hereby consent to participation by my child/children in the field trips. I understand that this will take place away from the school grounds and that my child will be under the supervision of the designated program employee on the stated dates. I also understand that this field trip may expose my child/children to some risks and I assume any such risk that may arise there from, I accept full responsibility for all medical expenses for any injuries that might occur to my child by reason of his/her participation. As a parent/guardian, I hereby give my consent to ride with a director/teacher/ Creative Kids employees/student and for commercial transportation provided by Creative Kids to practice the trip. I do hereby waive, release, absolve, indemnify and agree to hold harmless director/ teacher/ Creative Kids employees/students transporting my student to or from for any claim arising out of any injury to my child.

If my child requires emergency medical care and I cannot be reached, I give my consent to Creative Kids to obtain thenecessary medical care for my child/children. I agree to pay all of the costs associated with the medical care that my child/children receive. I understand that every effort will be made to contact to me before medical care is provided. If illness or an emergency arises, Creative Kids program may contact emergency contacts in the application form, if parent is not available. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to him/her.

I give my consent for him/her to participate in any and all events, activities and field trips sponsored and endorsed by the Creative Kids. I hereby release, indemnify and hold harmless Creative Kids members, employees,volunteer workers, agents, and assigns from any and all liability, injury, damage claim of any nature whatsoever arising out of or in any way related to my/my child's participating in this event. Participating in any activity is an acceptance of some risk of injury. I agree that my son's/daughter's safety is primarily dependent upon his/her taking proper care of himself/herself. Despite precautions, accidents and injuries may occur and injury and/or loss or damage to personal property may occur as a result of participation in this event. Therefore, I assume all risks related to the activities. Every precaution will be taken to prevent injury or accidents. However, the Creative Kids personnel cannot accept responsibility should they occur. In case of an emergency and if I cannot be reached, I do hereby authorize a medical personal or a representative of the Creative Kids personnel to administer any medical procedure which in their judgment may be necessary and to act in best judgment for all emergency treatment. I hereby authorize the medical personnel (If available), Director, or a representative of the Creative Kids to administer minor medications, such as Tylenol, aspirin, Ibuprofen, Pepto-Bismol, Neosporin and basic First Aid.

I further understand that it is my responsibility to keep current information contained in the records held in the Creative Kids main office including, but not limited to, my address, phone number, emergency contact and insurance information.

The parent/guardian has read the foregoing RELEASE AND WAIVER OF LIABILITY AGREEMENT and by accepting the waiver intentionally and voluntarily agrees to its terms and conditions. The parent/guardian further certifies that my son/daughter is in good physical condition and is able to safely participate in the Please notify the Creative Kids staff promptly of changes in email address and other contact information. Staff and volunteers of the Creative Kids will keep all information confidential.

I am aware, understand and acknowledge that participation in Creative Kids program is a potentially hazardous activity and involves inherent risks of danger or injury. including but not limited to, sprains, strains, fractures, concussions, contusions, lacerations, abnormal blood pressure, heart disorders, fainting, shortness of breath, chest pain, strokes, heart attack, or even death that can occur (hereinafter collectively referred to as "RISKS" I am voluntarily participating in Creative Kids program with the knowledge of the danger involved with the RISKS and with the knowledge that staff assistance and/or medical facilities may not be available in the event of illness or injury. I HEREBY AGREE TO ACCEPT ANY AND ALL RISK OF INJURY, ILLNESS, OR DEATH INHERENT IN CREATIVE KIDS PROGRAM AND VERIFY THIS STATEMENT BY PLACING MY SIGNATURE BELOW. I HAVE CAREFULLY READ THIS WAIVER, RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND A LEGAL CONTRACT BETWEEN ME AND CREATIVE KIDS ANDTHAT IT AFFECTS MY LEGAL RIGHTS. I AM SIGNING THIS DOCUMENT OF MY OWN FREE WILL.