EMERGENCY RELEASE FORM

Please fill out this form once for each child that attends Little Tree. We will keep this on record and use it for any reason that we need to contact you during or outside of business hours.


CHILD'S INFO
Little Artist's Name *
Little Artist's Name
Birthday *
Birthday
Sibling- Little Artist
Sibling- Little Artist
Birthday
Birthday
Photo release *
From time to time kids may be photographed while in our sessions. If you are opposed to having any family members appear in public photos, on our website or other promotional materials, please let us know. These photos will be used on our blog to discuss and share our on-goings and lessons.
Guardian' information
Parent or Legal Guardian's name *
Parent or Legal Guardian's name
Parent's phone *
Parent's phone
Monthly email updates *
Emergency contacts
Emergency contact's name *
Emergency contact's name
Emergency contact's phone # *
Emergency contact's phone #
Emergency contact's name
Emergency contact's name
Emergency contact's phone #
Emergency contact's phone #
Release of Liability Contract
Lunch/Recess *
All camp classes will begin and end at Little Tree Studios *Drop off and pick up is at; 14 Ross San Anselmo Each day we will take our lunch off-site. Children will walk to Robson Park for lunch and recess for 90 min. All policies listed in this Emergency Form (ie: liability and medical) apply during camp hours regardless of location. By signing below, you agree to not hold Little Tree Studios and its teachers liable for any accidents that occur while attending off site events during Summer Camp.
RELEASE OF LIABILITY AND ACKNOWLEDGEMENT OF POLICY *
I agree to release, waive, discharge, indemnify and save and hold harmless Little Tree Studios, its directors, officers, employees, and agents from any loss, liability, damage, or costs they may incur due to my or my child(ren)’s presence in, upon or about Little Tree Studios premises or in any way observing or using any facilities or equipment of Little Tree Studios, either during or outside of assigned class time, whether caused by the negligence of Little Tree Studios or otherwise.
Consent *
I authorize teachers at Little Tree Studios to secure for the services of emergency transportation, a physician, or a hospital in the event of accident or illness. I will be responsible for payment of all services. This consent for treatment is in effect only during the actual program hours and dates that the above named child is participating in Little Tree Studios classes and/or camps.
Risk *
I accept that there are potential risks and dangers inherently associated with art activities including but not limited to: sharp metal tools such as pottery tools, hot glue guns, sewing machine, ingredients in paint that are harmful if ingested in large quantities and more. I accept that there are potential risks and dangers inherently associated with art activities involving off-site visits and field trips including but not limited to: traffic accidents, playground injuries, and crossing streets. I the parent, accept full responsibility for any losses or damages to me or my child(ren), however caused or alleged to be caused.
Payment *
I accept that I am responsible for paying Little Tree Studios the full tuition for any classes in which I have reserved a seat for my child unless cancelled 30 days in advanced.