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* 1. Participant Name

Child(ren) under the age of 18 left unattended at the workshop by their parent or guardian: The parent or guardian is responsible for promptly picking up child(ren) at the end of the scheduled workshop time.

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* 2. Child Name (N/A if only adult participant)

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* 3. Date of Birth (N/A if only adult participant)

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* 4. Parent/Guardian Name (N/A if only adult participant)

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* 5. Address

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* 6. Cell Phone

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* 7. Work Phone

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* 8. Home Phone

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* 9. Email Address

PARTICIPANT & PARENT’S AUTHORIZATION & WAIVER FORM: I give permission to Ogden Contemporary Arts to use photos taken of me and/or my child at the Artist Factory Studio as well as photos of me and/or my child’s artwork to be used for local news and marketing, including OCA Newsletters. I also give permission to Ogden Contemporary Arts to use photos taken of me and/or my child and me and/or my child’s artwork to be used for marketing on social media, including Facebook, Instagram, and LinkedIn.
ABILITY TO ENGAGE IN ART ACTIVITIES AND ASSUMPTION OF THE RISK: Ogden Contemporary Arts takes all possible precautions to reduce risk and provide safe, healthy and enjoyable experiences. I warrant that I am and/or my child is able to follow directions for all activities in the studio/class. I acknowledge that risks from participation in class activities exist and that I have allowed myself and/or my child to attend art class knowing these risks and their possible consequences including personal injury.
WAIVER AND RELEASE OF LIABILITY: As a participant and/or parent or guardian of my child, I agree that I will not hold Ogden Contemporary Arts liable for any personal injury, property damage or loss of insurance. I agree to release and hold harmless Ogden Contemporary Arts from all liability incurred as a result of my and/or my child’s participation in studio class and that these terms serve as a release for me, volunteers, property owners and members of my family.
I am the participant and/or parent/guardian of the child that I am registering for classes at Ogden Contemporary Arts: Artist Factory Studio Workshops.

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* 10. PARTICIPANT/PARENT/GUARDIAN SIGNATURE

PLEASE COMPLETE THIS SECTION IF YOU’RE DROPPING YOUR CHILD OFF
PICK UP: Please list all who are authorized to pick up your child. Please give us their full name and contact phone number. We take the safety of your children very seriously and will check the driver’s license before releasing your child (with the exception of First Fridays--Please do not leave your child(ren) unattended).

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* 11. Name

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* 12. Name

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* 13. Name

MEDICAL EMERGENCIES: The undersigned gives permission to Ogden Contemporary Arts, its staff and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health. If necessary, I request that my child be transported to a nearby hospital.

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* 14. HOSPITAL CHOICE

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* 15. EMERGENCY CONTACT NAME

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* 16. RELATIONSHIP

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* 17. Emergency Contact

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* 18. PHYSICIAN (NAME/ADDRESS/PHONE)

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* 19. ALLERGIES/MEDICAL CONDITIONS/SPECIAL REQUESTS

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* 20. PARTICIPANT/PARENT/GUARDIAN SIGNATURE

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* 21. Date

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