Co-Creation Workshop Form

- A minority run nonprofit corporation based in Poughkeepsie NY
- Email: info@enjinnarts.org
- Website: www.enjinnarts.org
Co-Creation Workshop Form

Parental Consent
I confirm that I am the parent/legal guardian of
First Name* Last 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 per session for their participation.

Name: First Name* Last Name*
Signature: (Please type your full name here to indicate your agreement to the permissions statements above)*
Date:Date
Contact Details
Name of Student*

First NameLast Name
Contact details

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Phone Number
Please enter a valid phone number.
Additional Emergency Contact
Please enter a valid phone number.
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.
Photographic & Video Consent
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:blanks*
Age: blank*

Print Name: First Name* Last Name*
State Relationship to the child:Type a label*
Phone Number: Area Code* Phone Number*
Signature: (Please type your full name here to indicate your agreement to the permissions statements above)*
Date:Date
Should be Empty:

Contact Details

Photographic & Video Consent