Once you have REGISTERed THROUGH OUR Studio & Group link VIA EVENTBRITE AND fill out thIS form completely. Once you've reached the end of the form please sign and give consent.
Participant *
Participant
Birthdate
Birthdate
Self/Guardian/Parent
Self/Guardian/Parent
Required if signing for a minor
CONTACT INFORMATION:
Phone Number
Phone Number
Emergency Contact
Emergency Contact
Emergency Contact Number
Emergency Contact Number
Important Information:
Release of Liability and User Agreement. * IN CONSIDERATION of my involvement with The Violet Hive Art Therapy and Healing, I acknowledge and agree that: (1) We risk bodily injury, including paralysis, dismemberment, disability and death, and while particular rules of the sport, equipment, personal training and discipline may reduce this risk, the risk of injury does exist, as well as the risk of damage to or loss of property; (2) We knowingly and freely assume all such risks, both known and unknown, even if arising from negligence of the releases or others; (3) We willingly agree to comply with the above stated and customary terms and conditions for participation. If, however, we observe any unusual or unnecessary hazard during my presence or participation, we will bring such to the attention of the nearest instructor immediately; and (4) I, for myself and on the behalf of my heirs, assigned, personal representatives, and next of kin, hereby release, hold harmless Violet Hive Art Therapy and Healing, volunteers, teachers, artists,officials, agents, sponsors, clubs and/or employees, with respect to any and all injury and loss arising from my participation, whether caused by the negligence of the releasees or otherwise, except that which is the result of gross negligence or wanton misconduct, to the extent permitted by the applicable law. (5) I understand that my child’s photograph maybe used in their artwork, likeness may be published to social media and/or the Violet Hive Art Therapy and Healing website (violethiveart.org). If all involved affiliated with the event agree to the above terms, please sign below.
By selecting 'I agree' I am providing consent for myself or child to participate.