Little Barn Farm Art Workshop Liability Waiver

Little Barn Farm Art Workshop Liability Waiver

Please complete this form to allow your child to participate the Little Barn Farm Art Workshops and acknowledge the waiver of liability.
Little Barn Farm Art Workshop takes place in the home studio/garage of Chealsey Gerth, licensed Art Educator in Wisconsin. It's purpose is to enrich our community with arts experiences that inspire, empower, educate, and entertain. The premise is to diversify education in various techniques inspiring enthusiasm in our community and providing easy access to skills associated children's Art. We will be using materials for basic art creation such as/but not limited to; paper, tempera paint, watercolor paint, pencils, crayons, oil pastels, markers, scissors, glue. We work from the basics to the advanced. Education and instruction is based on an established program offered for children.

In consideration for participating in Little Barn Farm Art Workshops, I, on behalf of myself, my heirs, personal representatives, agents and assigns, hereby release, waive, discharge, and hold harmless Chealsey Gerth and Little Barn Farm and Vineyard from any and all claims, liabilities, damages, or causes of action arising out of or in connection with my participation in the workshops, including any personal injury, illness, property damage or loss caused by Chealsey Gerth and Little Barn Farm and Vineyard negligent acts or omissions while on Chealsey Gerth's and Little Barn Farm and Vineyard's premises.

I agree to defend, indemnify and hold harmless Chealsey Gerth and Little Barn Farm and Vineyard, its members, directors, officers, employees, representatives, and agents, for any and all personal injury or property damage claims arising from my negligent, willful or intentional act while participating in the art workshop or while I am on Chealsey Gerth's premises, wherever, whenever and however the claims may arise.

I voluntarily assume any and all risks of participating in Little Barn Farm Art Workshop and accept full liability for any damages, expenses, loss of property, personal injury to Chealsey Gerth or other persons participating in the Workshop, resulting from my negligence, willful or intentional act.
Child's Full Name*

First NameLast Name
Child's Date of Birth*

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Date
Child's Gender
Parent/Guardian Full Name*

First NameLast Name
Relationship to Child*
Parent/Guardian Phone Number*
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Parent/Guardian Email Address*
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Emergency Contact Name*

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Emergency Contact Phone Number*
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Please list any allergies, medical conditions, or special needs your child has (if none, enter 'None')*
I do not consent
Parent/Guardian Signature (please sign below to acknowledge and consent)*
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