Child's Name: Child One
Child's Age:
CERTIFICATION OF PHYSICAL FITNESS/MEDICAL CONSENT
I allow my child to participate in physical fitness activities at Camp MusArt LLC. Physical fitness activities include, but are
not limited to: dance classes, ball games, yoga, playground activities, and any other outdoor/indoor physical activities that
may be offered by Camp MusArt LLC. I fully understand the level of physical activity involved in these programs and
certify that my child is physically fit, and there are no medical reasons why she/he cannot participate in these programs. I,
the undersigned parent or guardian, understand that an emergency situation may arise where the delay of medical or
surgical procedures could endanger the well-being of my child. I do hereby grant permission to the staff of Camp MusArt
LLC to render judgment in my absence concerning medical assistance or hospital care in the event of accident or illness. I
understand that Camp MusArt LLC will not administer any medications to my child.
Initial
LIABILITY WAIVER
I, the undersigned parent or legal guardian for (Name of Camper/Student)
Child One (the "Child"), in enrolling my child in Camp MusArt LLC’s programs and activities for the Initial
Date
Feb 06, 2023
I understand, warrant, and covenant that I am intentionally and freely waiving and releasing my rights and the rights of the Child to the fullest extent allowed by North Carolina law in this regard and do so voluntarily and knowingly in order that the Child may participate in Camp MusArt LLC’s programs.Initial
Date Feb 06, 2023
Prior to voluntarily agreeing to and signing this release and waiver, I have been given the opportunity to review and inspect and have reviewed and inspected the premises and equipment to be used in conducting the activities and programs at Camp MusArt. I also have been given the opportunity to discuss and have discussed with program organizers or staff any potential hazards and risks that may be associated with the activities and take full responsibility for doing so for myself and for the Child. I understand and acknowledge Camp MusArt LLC does not provide transportation to or from activities. I also understand and acknowledge that Camp MusArt LLC does not provide health, medical, accident, or any other insurance for the Child while enrolled and/or participating in Camp MusArt LLC programs or activities.
Initial Date Feb 06, 2023
Signed:
Legal name:
Parent or Legal Guardian for Name of Camper / Student: Child One
Date: Feb 06, 2023
Period / Term covered by this Waiver and Release:
Photo/Video policy: I hereby grant my permission to allow the use of voice, video, image, or likeness of my child to be
taken without identifying information to be used by the Camp MusArt for promoting their programs. The permission for
use of any of the media above is allowed for (check all that apply):
Initial
Tasting policy: Sometimes at Camp MusArt food is offered to the children occasionally, like tasting fruits or vegetables
grown in our garden or sharing a treat brought by another student or a teacher. We would like to request your permission to
allow your child eat the food offered at Camp MusArt. Please feel free to make comments below as necessary.
My child is
allowed
not allowed
to have a snack, treat, or taste given by Camp MusArt. Initial My child is
allowed
not allowed
to have their face painted. Initial
Video Watching: We occasionally play educational or G Rated programs for approximately 15 minutes each during snack
and lunch, and for 15 to 30 minutes during carpool and pre-recital time. My child is
allowed
not allowed
to watch these programs. Initial
My signature below is evidence of my approval and acceptance of the terms of this waiver. I understand this waiver is in
effect until I provide, in writing, a cease order. I also agree to forego any right or entitlement I might have to any
compensation or fee. Finally, I agree that I am the legal guardian of the child named above.
Parent/Guardian Signature:
Date: Feb 06, 2023
