MixMatched Creations — Parent/Guardian Waiver & Agreement Form

MixMatched Creations — Parent/Guardian Waiver & Agreement Form

For Art Classes, Workshops, and Birthday Parties Instructor: Jess Rothstein Email: mixmatchedcreations@gmail.com Phone/Text: 908-268-9076 Please read and sign the agreement below. This form is required for participation in any MixMatched Creations class, event, or party.
Parent/Guardian Full Name*

First NameLast Name
Child's Full Name*
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
1. PHOTO & MEDIA RELEASE (OPTIONAL)

YES, I grant permission for MixMatched Creations to capture, use, publish, display, reproduce, and distribute photos/videos of my child and their artwork in any media now known or later developed.NO, I do NOT grant permission.If YES is selected, the following must also be agreed to: I understand and agree to the full Photo & Media Release, including irrevocable, perpetual, royalty-free use of my child’s image, waiver of approval rights, and release of all related claims.
2. 2. GENERAL LIABILITY WAIVER, RELEASE OF CLAIMS & ASSUMPTION OF RISK (Required)Participation involves inherent risks including, but not limited to, the use of art tools, materials, equipment, movement around the classroom, and interaction with other participants. By permitting participation, I voluntarily assume all risks, whether known or unknown, and release MixMatched Creations from any and all liability except where prohibited under New Jersey law (i.e., gross negligence or intentional misconduct).Required agreement:*

I have read and agree to the General Liability Waiver, Release of Claims & Assumption of Risk.
3. MEDICAL RELEASE, EMERGENCY AUTHORIZATION & LIABILITY WAIVER (Required)I authorize the instructor to provide minimal/basic first aid and to contact emergency services if deemed necessary. I am fully responsible for all medical expenses. I agree to fully disclose all medical or behavioral information. Failure to disclose releases MixMatched Creations from liability relating to such nondisclosure.Required agreement:*

I have read and agree to the Medical Release, Emergency Authorization & Liability Waiver.
4. ALLERGY DISCLOSURE & AGREEMENT (Required)MixMatched Creations cannot guarantee an allergen-free environment. I agree to fully disclose all allergies and provide necessary medication/instructions. I accept full responsibility for allergic reactions, including those resulting from undisclosed or inadvertent exposures.Required agreement:*

I have read and agree to the Allergy Disclosure & Agreement.List ALL allergies, sensitivities, or medical conditions (Required):No known Allergies
If known allergies please list them here:
5. ILLNESS POLICY (Required)I agree to follow all illness-related attendance rules and understand that missed classes due to illness are not refundable.Required agreement:*

I have read and agree to the Illness Policy.
6. PICK-UP & SUPERVISION POLICY (Required)MixMatched Creations is not responsible for supervision before the scheduled start time or after the scheduled end time. Only individuals listed below may pick up the child. Late pick-ups may result in dismissal without refund.Required agreement:*

I have read and agree to the Pick-Up & Supervision Policy.
List all authorized pick-up individuals (Required): If none, write “Parent Only.”
7. BEHAVIOR & PARTICIPATION AGREEMENT (Required)Unsafe, aggressive, disruptive, destructive, or harmful behavior may result in removal without refund. MixMatched Creations is not responsible for incidents arising from the child’s behavior or interactions with others.Required agreement*

I have read and agree to the Behavior & Participation Agreement.
8. MATERIALS, MESS & PERSONAL PROPERTY POLICY (Required)Art materials may stain or damage clothing and personal items. Aprons are provided but do not guarantee protection. MixMatched Creations is not responsible for damage to clothing, shoes, coats, jewelry, or any personal belongings.Required agreement:*

I have read and agree to the Materials, Mess & Personal Property Policy.
9. PAYMENT, REFUND & CANCELLATION POLICY (Required)All payments are final. Missed classes, no-shows, schedule conflicts, child illness, or behavioral removal are non-refundable. Weather or instructor-related cancellations will be rescheduled; rescheduling is the sole remedy.Required agreement:*

I have read and agree to the Payment, Refund & Cancellation Policy.
10. WEATHER & INSTRUCTOR ILLNESS POLICY (Required)In the event of hazardous weather, unsafe travel conditions, building closure, or instructor illness, classes will be rescheduled only. No refunds or credits will be provided.Required agreement:*

I have read and agree to the Weather & Instructor Illness Policy.
11. ABSENCES & MISSED CLASSES POLICY (Required)Make-ups are not guaranteed. No refunds, prorating, credits, or transfers will be issued for absences.Required agreement:*

I have read and agree to the Absences & Missed Classes Policy.
12. INDEMNIFICATION CLAUSE (Required)To the fullest extent permitted by New Jersey law, I agree to indemnify, defend, and hold harmless MixMatched Creations from all claims arising from my child’s actions, nondisclosures, rule violations, or participation in the program.Required agreement:*

I have read and agree to the Indemnification Clause
13. GOVERNING LAW, SEVERABILITY & VOLUNTARY CONSENT (Required)This Agreement is governed by New Jersey law. If any section is deemed unenforceable, the remainder remains in effect. I sign voluntarily and acknowledge that this document constitutes informed consent and waiver of certain legal rights.Required agreement:*

I have read and agree to the Governing Law, Severability & Voluntary Consent Statement.
14. ARTWORK STORAGE DISCLAIMER (Recommended)I understand that while every effort will be made to store artwork safely, MixMatched Creations is not responsible for damage to artwork stored on-site.This covers:Wet paintKids touching each others’ artworkChurch accidents

I have read and agree to the art work storage disclaimer
Date of Signature*

MonthDayYear
Date
Parent/Guardian Signature*

Powered by Jotform SignClear
Should be Empty: