Art Feeds Registration for Art Feeds, meeting Wednesdays from 3-5pm. Participant's Name* First Last Participant's AgeParticipant's Gender Identification (click as many as you like!) Female Male Non-binary Trans Cis First Parent-Guardian's Name* First Last First Parent-Guardian's Email* First Parent-Guardian's Phone Number*Second Parent-Guardian's Name First Last Second Parent-Guardian's Contact Information AllergiesIf participant has allergies describe all allergens, all allergic reactions and any medication (i.e. epipen, benadryl) that need to be administered.Physical / Medical ConditionsDoes the participant have any physical or medical conditions that could result in an emergency or preclude them from engaging in certain activities?MedicationsPlease list all medications (including over-the-counter or nonprescription drugs) taken routinely.P1: Social Emotional Well-being* Is there anything else our artists need to know about the participant that would help us provide the best experience for them?INDEMNIFICTION and RELEASE of CLAIM AGREEMENT* I have carefully read this agreement and understand it to be a release of all claims and causes of action for myself and/or my children's injury, illness or death and damage to my property that occurs while participating in the described program.In Consideration of myself and/or the children I am now registering being allowed to participate at the Holter Museum of Art, I the undersigned, on my own behalf and on the behalf of my children, acknowledge, appreciate and agree to the following conditions: 1) I represent that I am the parent or legal guardian of the children I am now registering. 2) I agree that I and/or my children shall comply with all stated and customary terms, posted safety signs, rules and verbal instructions as conditions for participating in Holter Museum of Art's activities. 3) I am aware that there are inherent risks associated with participation in Holter activities and I, on behalf of myself and on the behalf of the children I am registering today, knowingly and freely assume all such risk, both known and unknown, including those that may arise out of the negligence of staff and other participants. I hereby allow my children to participate in Holter activities. I do hereby release, discharge, and hold harmlessHolter Museum of Art, its employees, volunteers, agents and assigns from any and all claims, demands, rights and/or causes of action whatsoever kind or nature arising from or by any reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, loss and/or damage to property, and the consequences thereof resulting or which may result from myself and/or my children participating in the camp activities. 4) I understand that all participants are expected to follow directions and be safe while atthe Holter. It is particularly important that participants stay with the group to ensure they are being supervised. If my children are creating conditions that may harm themselves or another participant, the Holter reserves the right to require my presence during activities. If behaving in a way that is dangerous to self or others and in instances of extreme or repeatedly disobeying staff directions, the Holter Museum of Art reserves the right to dismiss myself and/or my children from the rest of a session. 5) I give my consent for the personnel of Holter Museum of Art to secure emergency medical care and/or first-aid treatment, for myself and/or my children named above, as emergency conditions might require while under supervision of said personnel. I authorize the Holter staff or their agents to arrange transport of myself and/or my children to a healthcare facility for emergency services as needed. 8) I hereby acknowledge that the Holter Museum of Art will assume that either parent-guardian of the children may pick up the children at any time during the program unless there is pertinent court documentation on file that indicates otherwise. 9) If my children have allergies or other medical conditions and I expect that it may be necessary for the Holter Museum of Art to give my children medicine during the session, I will indicate this in the Health History Questionnaire above and send the medicine to camp with my children. I will provide a list of the medications with detailed instructions on administration of the listed medication. 10) I hereby grant to the Holter Museum of Art the right to use and publish photographs of myself and/or my children, or in which we may be included, for website design, editorial, trade, merchandising display and advertising for the purpose of promoting the activities of the Holter Museum of Art; to alter the same without restriction and to copyright the same. I hereby release the Holter Museum of Art from all claims and liability relating to said photographs.COVID 19 RELEASE* I have carefully read this agreement and understand it to be a release of all claims and causes of action for myself and/or my children's and/or any of my relatives injury, illness or death that stems from myself and my children participating in the described program.I understand that anywhere people are present there is an inherent risk of exposure to coronavirus and I understand that it is expected that I keep my child away from the Holter if they are running a fever, showing symptoms of COVID 19 or other transmissible illness or if they or someone they live with tests positive for COVID 19. I submit to my child's temperature being taken at the Holter and understand that the expectation will be for me to keep my child away from the Holter if they are running a fever. I acknowledge the contagious nature of COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that the Holter Museum of Art has put in place preventative measures to reduce the spread of the COVID-19. I further acknowledge that the Holter Museum of Art can not guarantee that my child and those they live with will not become infected with COVID-19. I understand that the risk of becoming exposed to and/or infected by the coronavirus may result from the actions, omissions, or negligence of my children and others, including, but not limited to staff, other clients, their families and their children. I voluntarily seek services provided by the Holter Museum of Art and acknowledge that I am increasing the risk of exposure to coronavirus of myself, my children and my family. I acknowledge that my children must comply with all set procedures to reduce the spread while attending Holter programming. To this end I also attest that: 1) My children are not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. 2) They have not traveled internationally within the last 14 days. 3) I have not traveled to a highly impacted area within the United States of America in the last 14 days. 4) I do not believe they have been exposed to someone with a suspected and/or confirmed case of COVID-19. 5) They have not been diagnosed with COVID-19 and not yet cleared as non contagious by state or local public health authorities. 6) That I and my children are following all CDC recommended guidelines as much as possible and limiting our exposure to coronavirus/COVID-19. 7)They will come to camp with a face mask and consent to wearing their mask while at camp. 8) They will maintain at least a 6' distance from all other participants they are not currently housed with.NameThis field is for validation purposes and should be left unchanged.