Bloodroot Writers Collective Waiver

Bloodroot Writers Collective Waiver & Photo Release
Student Information
Name of student*

First NameLast Name
Name of guardian*

First NameLast Name
Guardian Phone Number*
Please enter a valid phone number.
Guardian Email*
example@example.com
Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student date of birth*

MonthDayYear
Date
Students Current Grade Level*
Food & Medical Needs
Please list any allergies your student has.*
Does your student have any dietary restrictions? *
Medical Information: For your student’s safety, please list any medical conditions or medications we should be aware of (e.g., asthma/inhaler use, allergies, EpiPen needs, or other health concerns). This information will be kept confidential and used solely to ensure proper care and preparedness.*
Safety Acknowledgment & Liability Waiver

By enrolling your student in the Bloodroot Writer's Collective, I acknowledge and agree to the following
Safety & Behavior Acknowledgment
I understand that the Bloodroot Writers Collective (BRWC) volunteers and staff will make every reasonable effort to provide a safe, welcoming, and enriching environment. I agree that:
- My student will follow all safety guidelines and instructions from BRWC staff.
- Disruptive, aggressive, or unsafe behavior may result in my student being dismissed from the BRWC program.
- I will notify the staff of any allergies, medical needs, or special considerations.
Personal Belongings & Lost Item
I understand and agree to the following terms regarding my student’s personal belongings while attending the Bloodroot Writers Collective at the Rowan County Art Center:
- Lost or Missing Items: The Bloodroot Collective and the Rowan County Art Center are not responsible for any lost, misplaced, stolen, or damaged personal items, including clothing, water bottles, bags, or electronics.
- Unclaimed Items: Any items left behind will be held in the lost and found for one week. After that time, unclaimed items may be discarded or donated at the discretion of the art center.
Injury Liability
By enrolling my child in the Bloodroot Writers Collective, I acknowledge and agree to the following:
- I understand that while the Rowan County Arts Center takes all reasonable precautions to provide a safe environment, participation may involve inherent risks, including minor cuts, scrapes, or accidents.
- I hereby release, waive, and hold harmless the Rowan County Arts Center, its staff, instructors, volunteers, Bloodroot Writers Collective, and its partners, including the James Baker Hall Foundation, from any and all liability, claims, demands, or causes of action for injuries, damages, or losses that may arise out of or in connection with my student’s participation in camp activities, whether occurring on or off the premises.
- I accept full responsibility for any medical treatment that may be necessary and authorize the the Rowan County arts Center staff to seek emergency medical care for my student if I cannot be reached.
  
  By signing below (or checking the acknowledgment box during online registration), I confirm that I have read, understood, and agree to this waiver of liability.
Signature*

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Photo & Media Release
Consent to Use of Images and Media
I hereby grant permission to the Rowan County Arts Center, Bloodroot Writers Collective, and its partners, including the James Baker Hall Foundation, to record, photograph, and/or video my/my student’s participation in programs, workshops, performances, and related events.

I understand that these photographs, video footage, or audio recordings may be used for the following purposes:
- Promotional materials (print, website, and social media)
- News and press coverage
- Educational or archival use
- Grant reporting and fundraising documentation
I understand that:
- No personal identifying information (such as full names or contact information) will be used without further permission.
- The use of these materials is solely for non-commercial purposes in support of the mission and activities of the Bloodroot Writer’s Collective and its partners.
I do consent to the use of images and recordings as outlined above.*

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Bloodroot Writers Collective Waiver & Photo Release

Student Information

Food & Medical Needs

Safety Acknowledgment & Liability Waiver

Photo & Media Release