Students Name *

First Name

Last Name

Guardian Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Consent Waiver

My student has my permission to participate in the After School Arts Program hosted by Englewood Christian Church on Tuesday afternoons from 4-5 PM. By granting permission for my child to participate in After School Arts, I understand that I am agreeing to be responsible for my child getting safely to and from the program site each week. I am also giving permission to seek medical care for my child should they get injured while participating in this program. I hereby give the program personnel permission to give needed first aid or use their judgment in obtaining emergency medical services if they feel it is needed. I understand that Englewood Christian Church is not responsible to cover medical or hospital costs incurred and therefore, any costs incurred for treatment shall be my sole responsibility. I also understand that by giving permission for my child to participate in the program and acknowledge and take on any risk to for injury, accident, illness that may occur to my child during or by reason of participation in this program.

Yes

No

Text Message Communication *

Would you like to receive text messages to inform you about special events at After School Arts, weather related closures of After School Arts, summer and after school camps sponsored by After School Arts and free community art related events for kids. These texts can be stopped at any time by responding NO to a message.

Yes, please text me

No, do not text me.