Co-Creation parental-consent-form EnjinnArts v2

A nonprofit corporation based in Poughkeepsie NY

Email: info@enjinnarts.org Website: www.enjinnarts.org)

I confirm that I am the parent/legal guardian of

Student Name

First NameLast Name

I hereby consent to the above minor participating in the Enjinn Arts "Co-Creation" workshop at 5 p.m. Feb 6th, 12th, March 4th, April 8th, May 6th, June 3rd, July 1st, September 9th, October 7th, and November 4th 2024, at the Cunneen-Hackett Arts Center Theater. I have provided contact details below and undertake to inform Enjinn Arts of any changes to this information. I confirm that all details are correct and I am able to give parental consent for my child to participate in this activity. Students are responsible for appropriate conduct during the session and transportation to and from the Theater. Students will receive a $40 stipend for their participation.

Name

Signature

Date

Contact Details

Name of Student

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent's Mobile Phone No.

Additional Emergency Contact No 1

Please also include all medical details that might be relevant in dealing in with your student in a safe manner such as allergies medication special needs etc

I consent/do not consent to the below mentioned child being included in any photographic or video material, in any publications/websites/social network applications which may be used for the purpose of documenting and highlighting their involvement in the event.

Child Name

Age

Signature

Date

Name

State Relationship to child

Phone No.