Summer Art Camp Application
Email address *
Guardian Name *
Your answer
Guardian Phone Number *
Your answer
Student Name and Age *
Your answer
Class Desired (can choose one from each two-week session) *
Required
Are you applying for our need-based scholarship? *
Will your child need special assistance? *
Required
If YES, explain. *
Your answer
Does your child have any allergies or food requirements? (NOTE: we ask that you refrain from bringing outside food unless medically necessary for allergy reasons. If your child needs to eat, please mark "YES" and explain.) *
If YES, please list below. *
Your answer
We have a 30 minute pickup and drop-off window before and after classes. Will someone be able to pick up your child during that time? *
Please list everyone who may need to pick your child up/drop them off. Anyone on this list will be asked to show a valid photo ID upon arrival. Only people you add to this list will be able to take your child. *
Your answer
LIABILITY WAIVER
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY CONSENT AGREEMENT ("AGREEMENT") IN CONSIDERATION of being permitted to participate in any way in the activities of and/or on the premises of Cyclops Studios LLC, I, for myself for personal representatives, assigns, heirs, and next of kin: ACKNOWLEDGE, agree, and represent that I understand the nature of Cyclops Studios LLC activities and that I am sober, qualified, in good health, and in proper physical, and mental condition to participate in such Activities. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. FULLY UNDERSTAND THAT: (a) THESE ACTIVITIES MAY INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions or inaction’s, the actions or inaction’s of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) There may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Cyclops Studios LLC, their respective administrators, directors, agents, officers, members, volunteers, and employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of premises on which the Activity takes place, (each considered one of the "RELEASEES" herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
I have read and agree to the terms of this liability waiver (put name below). *
Your answer
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