Download PDF Release of Liability and Photo ReleasePlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.LayoutChild Name *AgeBirth DateLayoutSibling Name *AgeBirth DateAddressAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *IN CASE OF EMERGENCY ILLNESS, INJURY NOTIFY THE FOLLOWING CONTACTSLayoutParent Name *Phone (Cell/Work/Home)LayoutParent Name *Phone (Cell/Work/Home)LayoutCaregiver Name *Phone (Cell/Work/Home)LayoutOther Emergency ContactRelationshipPhoneLayoutDoctor Name *CityPhoneI hereby certify that the minor listed above is in my legal custody and has my permission to participate in the courses conducted by the ART ZONE. I further certify that the participant is in good health and has no physical or other impairment which would endanger the participant when engaging in such program.I absolve and hold harmless the ART ZONE, its employees, officers or agents from any liability which may result from participation in courses conducted by the ART ZONE. I understand that The ART ZONE has no obligation to supervise my child at the close of the above activity, and I release the ART ZONE, its officers, employees, and agent from any liability resulting from any lack of supervision of my child at the close of the activity. PHOTO RELEASE: Participants involved in the ART ZONE programs may be photographed and such photograph may be used to publicize ART ZONE programs/activities.LayoutParent or Guardian SignatureClear SignatureDateAllergies (if none, so state) Food RestrictionsCircle: Diabetes, Convulsions, Bleeder, Heart Condition, OtherList any other condition which should be known by physician administering treatmentLayoutClassStart DateSubmit