Parent and Field Trip Consent Form: July 26 Gallery Tour

Parent / Legal Guardian Name

First

Last

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Email

Phone #

Alt Phone #

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Information About Participating Child(ren)

Number of Children Participating

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Epi-Pen requirement

I require an Epi-Pen Form for one or more of the children listed above.

Medical Allergic Reaction Medication Administration Form

Please provide information about each child's most common allergies and reactions

I do hereby authorize and allow the Georgian Bay School of the Arts (GB Arts) and all of its employees and other affiliated persons to administer emergency anaphylactic shock medication to my child listed on this form for the purpose of alleviating the symptoms of an allergic reaction. I hereby fully and forever waive, relinquish, release and discharge GB Arts and all of its employees and other affiliated persons, from any and all claims, demands and causes of action from this emergency allergic reaction medication administration. I agree not to sue GB Arts or any of its employees and other affiliated persons as a result of any claim, injury or event that may occur as a result of this agreement. I have provided GB Arts with the emergency medication that my child requires in the event of anaphylactic shock. I have advised GB Arts on the medication’s use and administration according to the terms of the medication’s instructions and disclaimers.

I agree

I request that GB Arts maintain this medication in a refrigerated environment per the terms of the manufacturer’s recommendations as provided in the medication’s instructions and disclaimers.

Yes
No

Emergency Contact and Pick Up

Emergency Contact Name

First

Last

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Emergency Contact Phone #

Emergency Contact's Relationship to Child

Who is authorized to pick up your child?

For each individual, please provide their names and relationship to the child

Field Trip Consent

Type of event: Gallery Tour and Plein Air Drawing

Location of event: The Tom Thomson Art Gallery, 840 1st Ave W, Owen Sound, ON N4K 4K4

Individual(s) in charge: Elizabeth Hobe – Youth Programmer and Lead Teacher

Date and time of departure: Wednesday, July 26th at 1:15pm

Time of return: 3:30pm

Mode of transportation to and from the event: Walking

Field trip consent

I grant permission for my child(ren) to participate in this field trip event that requires walking or transportation. This activity will take place under the guidance and direction of employees and/or volunteers from GB Arts.

Kids Camp Code of Conduct

Please make sure you have read the Kids Camp Code of Conduct before proceeding.

Has read kids camp code of conduct

I have read and fully understand and agree to the Kids Camp Code of Conduct.

Waiver and Release of Liability

Due to the nature of this arts program, the risk of injury exists. I am voluntarily permitting my child(ren) to participate in the program activities with the knowledge that, although GB Arts takes all safety precautions, there may be hazards involved. I release GB Arts of and any of its agents from any and all responsibility of liability.

In permitting my child(ren) to attend programming operated by GB Arts, I, the undersigned, in the event of an accident or illness affecting the child(ren) indicated on this form, authorise all procedures, including the admission to the hospital and necessary treatment herein as deemed essential for the care and well-being of said child(ren). Such action is to be taken only when immediate contact with the undersigned or other indicated authorised contacted cannot be made.

Agreed to waiver and release of liability

I agree

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I permit test photographs and/or video footage to be taken of my child, that may be used ONLY for marketing purposes (print and social media), by GB Arts.

Yes
No

I would like to subscribe to GB Arts monthly eNewsletter and give permission for my e-mail to be added to the list

Yes
No

Cancellation/Refund Policy

A full refund will be provided if:

The class is cancelled due to low enrolment
A student withdraws more than 5 days before the start of their scheduled class (subject to a 15% administration fee)
If there are road closures or severe inclement weather (class will be cancelled and makeup dates will be scheduled). Winter classes will typically go on as scheduled despite the presence of snow

No refund will be provided if:

A student withdraws less than 5 days before the start of their scheduled class
No exceptions for illness, including COVID-19
No price adjustments, makeup classes, or credits will be provided for missed sessions.

Agreement

Final agreement

I have read this agreement and fully understand and agree to the terms listed above.

Parent and Field Trip Consent Form: July 26 Gallery Tour

Information About Participating Child(ren)

Medical Allergic Reaction Medication Administration Form

Emergency Contact and Pick Up

Field Trip Consent

Kids Camp Code of Conduct

Waiver and Release of Liability

Cancellation/Refund Policy

Agreement

Thank you!