Mighty Girl Art Registration Form

Daughter's Name*

First NameLast Name

Age*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name*

First NameLast Name

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number*

Area CodePhone Number

Does your daughter have any allergies, or medical conditions? If yes, please describe.

Does your daughter have food allergy or dietary restrictions? If yes, please describe.

Is there anything you would like to share about your daughter?

What is your daughter looking forward to most at camp? What are her hopes for this experience?

Summer Drop-Off and Pick-Up Information: Parents must check in child at the meadow each day by 9:00 a.m. sharp and pick up child at Noon. *We start on time and late arrival cuts into your daughter's valuable creative time! In the event of stormy weather, drop-off and pick-up location will be at the art studio.

Please park on the right side of North Shore Drive for Drop-off and Pick-up. Meadow is located before Oak Spring Way. Trail will be marked with a garland. Studio is located just past Oak Spring Way. Trail will be marked accordingly.

Winter Drop-Off and Pick-Up Information: Parents must check in child at the studio at 9:00 a.m. sharp and pick up child at Noon. *We start on time and late arrival cuts into your daughter's valuable creative time! Please park on North Shore Drive just past Oak Spring Way. Trail will be marked.

Cancellation / Refund Policy: Request must be received 30 days prior to the session start date to receive a full refund of tuition and enable us adequate time to fill that space. Cancellations received after deadline will receive a 50% refund to help defray the cost of supplies purchased for your child.

Attire: We are making art and that can get messy so please dress accordingly. We also take nature walks so wear appropriate outerwear and footwear that can get wet a/o dirty. Summer Campers please wear insect repellent and sunscreen.

Bring: Please bring bottle of water and a snack. Bring your creative, adventurous heart!

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Mighty Girl Art™ during the selected camp. In exchange for the acceptance of said child’s candidacy by Mighty Girl Art™. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Mighty Girl Art™ and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Mighty Girl Art™ including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

A. Model Release

I hereby give to Mighty Girl Art™ the absolute and irrevocable right and permission with respect to the photographs that she has taken of myself and/or my minor child in which she may be included with others:

To copyright the same in the photographer’s name or any other name that she may select.
To use, re-use, publish and re-publish the same in whole or in part, separately or in conjunction with other photographs, in any medium now or hereafter known, and for any purpose whatsoever, including (but not by way of limitation) illustration, promotion, advertising.

I hereby release and discharge photographer from all and any claims and demands ensuing from or in connection with the use of the photographs, including any and all claims for libel and invasion of privacy.

B. Liability

Photographer is not responsible for any injuries inflicted upon any participating parties. Client(s) will be responsible for their children and for themselves and release photographer from any claims against their person or their business.

C. Copyright

Mighty Girl Art retains all copyrights to all images created. You are welcome to download photos for personal use.

The print release does not allow publication of your portraits (i.e. entering in contests), selling or altering of your images without the photographer’s written permission.

We work very hard to create images that reflect you and your family, while keeping in line with our artistic vision and creativity. I know you will want to share them for that very reason. We ask that you simply link back to our blog/website/facebook page.

Confirmation

I HAVE READ AND UNDERSTAND THE TERMS OF THIS CONTRACT. 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.

Signature*