Participant Signup Form (v. 7/26)

Youth Participant Information
Youth Name

First NameLast Name
Youth Birth Date

MonthDayYear
Date
Youth Shirt Size
Youth Shoe Size
Parent/Guardian Name

First NameLast Name
Parent/Guardian Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Relationship to Youth
Mother/Father/Guardian
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Email
example@example.com
Does your youth have any special needs, allergies, or prescribed medications? If so, please explain briefly.
For youth to complete (OPTIONAL): Please write a brief statement indicating why you want to participate in this project – what skills do you hope you will learn and how might you use them in the future?
Emergency Contact(s)
Parent/Guardian Signature

Multiple Participant or Family Information
Total Number of Adult Participants
Total Number of Youth Participants
Youth Participants
Adult(s) - Please enter information for at least one parent/guardian even if they do not plan to participate.
Emergency Contact(s)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does anyone listed above have any special needs, allergies, or prescribed medications? If so, please explain briefly.
Parent/Guardian Signature

Adult Participant Information
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Shirt Size
Shoe Size
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any special needs, allergies, or prescribed medications? If so, please explain briefly.
Emergency Contact(s)
Participant Signature

Photo, Video, and Evaluation Release Statement
By documenting the creative arts process from beginning to end and capturing the energy, enthusiasm, focus, and pride reflected in each participant’s face and work we will be better able to share the value and importance of the work to advocate for the continued exposure to and funding for the arts. The program will also administer a brief and anonymous evaluation survey to measure the program’s impact.

The photos and/or images of the participant(s) and his/her/their artwork work may be displayed and included in the printed and/or electronic media publications of the Watersmith Guild and/or its partner organizations including but not limited to; SurfSUP Adventures, Tree Pittsburgh, and Pittsburgh Parks Conservancy. These media publications include, but are not limited to: catalogs, newsletters, websites, and promotional videos.
Please select one:

ALLOW PHOTOS: I do give my permission to Watersmith Guild Inc. and/or the partner organizations, SurfSUP Adventures, to use the photograph(s)/video(s) of the listed participant(s) and/or images of his/her/their work for the above- stated purposes. I understand that there is no compensation of any kind for any use of his/her/their likeness(es) or images of artwork. Additionally, I do give my permission for the listed participant(s) to fill out an evaluation survey.
Signature
Today's Date

MonthDayYear
Date
Total Number of Participants

Please use this link to submit up to five waivers at a time. Please complete one waiver page for each participant. Please press submit on this page once you are done.

https://www.jotform.com/sign/261974396337067/invite/01kxrd5htb6415effa02e6272d
Clicking submit will bring up a waiver. Please complete one waiver page for each participant.
Please complete the waiver which will appear after clicking submit.
Should be Empty:

Participant Signup Form