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 guardians, in enrolling my child in Camp MusArt LLC programs, understand that my child is
participating in the programs and using the premises, including but not limited to the outdoor playground, at her/his own
risk. Camp MusArt LLC and its members, managers, officers, contractors, teachers and volunteers shall not be liable for
any damages whatsoever arising from any personal injury or property loss sustained by the participant and her/his family in
or about any programs on or off the premises. The camper and her/his parents assume full responsibility for all injuries and
damages that may occur in or about any premises with the Camp MusArt LLC programs and do hereby fully and forever
release, discharge and hold harmless Camp MusArt LLC, all associated facilities, and its managers, members, officers,
contractors, employees, teachers and volunteers from any and all claims, demands, damages, rights of action, present or
future resulting from or arising out of any person’s participation in any programs or use of its facilities. I understand that
Camp MusArt LLC does not provide health, accident, or any other insurance for my child while enrolled in Camp MusArt
LLC programs. Initial
As part of this approval, I have been given the opportunity to review the premises and equipment to be used in conducting
the activity. I also have been given the opportunity to discuss with program organizers potential hazards and risks that may
be associated with the activities and take responsibility for doing so. I understand Camp MusArt does not provide
transportation to or from activities. Initial
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: May 31, 2020
