Queer AF: Art + Fashion Youth Permission Slip (Ages 13-17)
This permission slip regards and relates to Queer AF: Art + Fashion, September 8, 2023, conducted by Love Your Labels, Inc. (the Organization). Any person age 13-17 without an 18+ chaperone must present this form completed in full or will not be permitted to participate in the Activity.
*Participation is voluntary.*
Field Trip (the Activity): Makeup is For Everyone | Address:61 Harvard St. Worcester, MA |
Youth Details:
Name: ________________________________________ | Date of Birth: __________________________________ |
Parent/Guardian/Caretaker Emergency Information:
Name:_________________________________________ | Phone #(s): ____________________________________ |
Residential Address: ____________________________ | Email address: _________________________________ |
Alternate Emergency Contact Name & Relationship: | Alternate Emergency Contact Person’s Phone #: |
Waiver (Initial):
YOUTH | ADULT | BOTH: I understand I/my child am/is expected to follow all applicable laws and am/is expected to follow the directions provided by the Organization and/or staff or volunteer(s). Failure to abide by these conditions may result in dismissal from the Activity. ADULT: I understand the event concludes at approximately 11:00 pm and that my child must be picked up and transported from Mechanics Hall by me no later than 11:30 pm, 9/8/2023. |
I give permission for my child to be transported to the nearest medical facility and secure medical treatment for my child, if necessary.
Health Insurance Provider: ________________________ | Preferred Local Hospital: __________________________ |
I hereby waive, release and discharge the Organization from any and all claims for damages or personal injury, death, or property damage which the child may have, or which may hereafter occur as a result of the child's participation in the Activity. It is understood that the Activity may involve an element of risk and danger of accidents and knowing those risks, I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns.
My signature on this form shall constitute an informed and knowing waiver as required by law. I acknowledge that I have carefully read this agreement, waiver, and release and fully understand its contents, and have provided emergency information. I am aware that this release of liability is a contract between myself and the Organization. My signature below also authorizes my child(ren) to participate in this voluntary event.
Parent/Guardian/Caretaker’s Signature: ______________________________________ | Date: _____/_____/_____ |