One on One Consent Form

Student's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the student prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Liability Waiver

I give permission for my child to participate in activities, classes, workshops, camps, outings, and related programs organized by Jenny T. I understand that participation may involve certain risks, including but not limited to physical activity, travel between locations, outdoor activities, and use of art materials and equipment.

I voluntarily assume all risks associated with participation and release, waive, and hold harmless Jenny T., its instructors, assistants, volunteers, affiliates, and property owners from any and all claims, liabilities, damages, injuries, or expenses that may arise from my child’s participation in these activities, except in cases of gross negligence or intentional misconduct.

I understand that accidents and injuries can occur despite reasonable supervision and safety precautions.

Medical Authorization and Emergency Care

In the event of an illness, injury, or medical emergency involving my child, I authorize Jenny T. and its staff, instructors, assistants, or representatives to obtain emergency medical care as deemed necessary.

I authorize licensed medical professionals to provide medical treatment, emergency care, diagnostic procedures, and other necessary treatment for my child if I cannot be reached immediately.

I understand that every reasonable effort will be made to contact me or my emergency contact as quickly as possible in the event of an emergency.

I accept responsibility for any medical expenses incurred as a result of emergency treatment.

Transportation and Walking Permission

I give permission for my child to participate in supervised walking activities, transportation between activity locations, outdoor classes, and off-site activities related to the program, including activities in public spaces, parks, trails, downtown areas, and nature-based environments.

Are there any concerns or restrictions regarding your child's participation in walking activities?

Photo and Media Release

I grant permission for photographs or videos of my child participating in activities to be used by Jenny T. for promotional, educational, website, and social media purposes.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

In consideration for allowing my child to participate in the walking activities described above, I hereby release, waive, discharge, and covenant not to sue the organizers, staff, or volunteers of the summer camp program for any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child while participating in such activities.

I understand that walking activities involve certain risks, including but not limited to trip hazards, uneven terrain, and encounters with vehicles or pedestrians, and I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by my child as a result of participating in such activities.

Date

Signature

Please verify that you are human

One on One Art Lesson Consent Form

Student Information