Participant Enrolment Form for Minors | The Dreaming Heart

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The Dreaming Heart
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PARTICIPANT ENROLMENT FORM for MINORS

Please submit this form before your child's first art class with the Dreaming Heart Art Studio.

One form must be completed for each child.

Please promptly resubmit the form anytime your child(ren)'s information changes.

We require a parent/legal guardian to complete the following information.

CHILD'S FULL NAME*

DATE OF BIRTH (DD/MM/YYYY)*

FULL NAME OF PARENT/LEGAL GUARDIAN #1*

Relationship to the child*

Main Phone #*

Alternate phone #

Email address*

HOME ADDRESS (street address, city, province, postal code)*

FULL NAME OF PARENT/LEGAL GUARDIAN #2

Relationship to the child

Main Phone #

Alternate Phone #

Email address

Home Address (street address, city, province, postal code). *If different than parent/legal guardian #1.

EMERGENCY CONTACT (other than parents/legal guardians)

Relationship to the child

Main Phone #

Alternate Phone #

ART CLASS ARRIVAL & DEPARTURE- My child will:*

Be signed in and out by an authorized person

Arrive at and leave the Venue independently (must be 10+ yrs.)

AUTHORIZED PERSONS- Are the parent(s)/legal guardian(s) and emergency contact(s) listed above authorized to sign in and sign out your child?*

Yes

No

N/A, my child will be arriving at and leaving the Venue independently.

If you selected NO, please list the full name(s) of the parent(s)/legal guardian(s) and emergency contact(s) who ARE authorized to sign in and sign out your child.

Are there any ADDITIONAL persons (other than parents/legal guardians and emergency contacts listed above) who are authorized to sign in and sign out your child?*

Yes

No

N/A, my child will be arriving at and leaving the Venue independently.

If you selected YES, please list the full name(s) of the additional authorized person(s) below and their relationship to your child. *Please do not complete this section if your child will be arriving at and leaving the Venue independently.

If you have indicated that your child will be signed in and out by an authorized person, the authorized person must enter the Venue upon drop-off and pick-up to sign the attendance logbook.*

I understand

HEALTH and MEDICAL ACKNOWLEDGMENT- I understand that The Dreaming Heart Art Studio does not manage participants' medical conditions or administer medications or other medical treatments. *

Yes

I agree to inform The Dreaming Heart Art Studio of any relevant medical conditions, allergies, medications, or other medical considerations that may affect my child’s participation.*

Yes

Please list any allergies, medical conditions, medications, or other medical considerations we should be aware of.

The Dreaming Heart Art Studio requires that all children who are prescribed an EpiPen, inhaler, and/or diabetic monitor carry their required medication/device(s) with them at all times while at the Venue. NO exceptions.*

I understand

The Dreaming Heart Art Studio does NOT guarantee an allergen-free environment. *

I understand

You assume all risk as it pertains to your child's allergies and medical conditions.*

Yes

You expressly grant The Dreaming Heart Art Studio consent to seek emergency medical care for your child when we are unable to contact you and when waiting for your consent would jeopardize the health and welfare of your child.*

Yes, I consent

The Dreaming Heart Art Studio may take photographs or videos of participants during classes or events for use in promoting the Studio, including on our website, social media, and other promotional materials.*

I give permission for my child to be photographed or recorded and for these images/videos to be used for promotional purposes.

I do not give permission for my child to be photographed or recorded.

Photo/video consent may be withdrawn at any time by contacting The Dreaming Heart Art Studio in writing via email at dreamingheartart@gmail.com.*

I understand

Is there any other information you would like to share with us about your child?

YOUR FULL NAME*

TODAY'S DATE*

By signing below, you confirm that you are the parent/legal guardian of the child(ren) listed above and that the information in this form is accurate and up to date. If any of the above information changes, please promptly resubmit this form.*

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