Clone of One on One Consent Form

Student's Name

First NameLast Name

Grade

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Optional Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Informed Consent and Liability Waiver

I voluntarily agree to participate in activities, classes, workshops, 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 the use of art materials, tools, and equipment.

I voluntarily assume all risks associated with my 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 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.

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 myself 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 being permitted to participate in the activities described above, I hereby release, waive, discharge, and covenant not to sue Jenny T., its instructors, assistants, volunteers, affiliates, and property owners from 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 I may sustain while participating in such activities.

I understand that these activities may involve certain risks, including but not limited to walking between locations, trip hazards, uneven terrain, encounters with vehicles or pedestrians, physical activity, and the use of art materials and equipment. I voluntarily assume full responsibility for any risks of loss, property damage, personal injury, or death that may result from my participation in these activities.

Date

Signature

Please verify that you are human

Adult One on One Art Lesson Consent Form

Student Information