Studio HQ Adult Consent Waiver – ArtReach San Diego

CONTACT INFORMATION

Name(Required)

First Last

Email Address(Required)

Email Address Confirm Email Address

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

EMERGENCY CONTACT INFORMATION

Emergency Contact Name(Required)

First Last

Must match photo ID

Phone(Required)

Relationship(Required)

CONSENT, WAIVER OF LIABILITY, AND MEDIA RELEASE

As an adult aged 18 or older, I agree to the following:

Engagement in Art Activities(Required)

I confirm that I am able to participate and follow all directions and instructions by ArtReach Teaching Artists. Disregarding studio rules and directions by ArtReach Teaching Artists and staff may result in immediate removal from the workshop. I understand that I am responsible for my own transportation to and from the workshop.

I agree to the above terms and conditions.

Risk Assumption(Required)

I acknowledge the risks involved in participation in workshop activities and various visual arts materials and tools, and am agreeing to attend and participate in ArtReach art workshops knowing these risks and potential consequences such as personal injury or loss of property. I understand that the studio space where the workshops are held will host other participants of all ages and that ArtReach is not responsible for any loss or damage of property to my personal items. I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at ArtReach may result from the actions, omissions, or negligence of myself and others, including, but not limited to, ArtReach employees and other participants.

I agree to the above terms and conditions.

Liability Waiver and Release(Required)

I hereby knowingly waive and release any and all known or unknown claim against ArtReach, its employees, board members, or other directly affiliated members, whether professionally or personally, including without limitation any actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees and costs, incurred due to claims brought by any third party as a result of or arising out of my involvement in activities and to reimburse ArtReach for any such costs, expenses and fees as they are incurred. Should any such claim, suit, cost, expense, or liability arise from the my involvement in ArtReach programs, the undersigned shall defend, indemnify, and hold ArtReach harmless from any potential liability caused, related to, or arising from the participant’s involvement and/or conduct.

I agree to the above terms and conditions.

Media/Photo Release(Required)

I permit ArtReach to use photos/videos of me for potential promotional materials on social media, email campaigns, grant reports, and marketing collateral.

Yes

Participant Certification(Required)

I hereby certify that have read and I understand all of the provisions of this document and the risks of activities.

I agree to the above terms and conditions.

Is there anything else you would like to share with us about your participation?