WEEK FOUR KIDS CAMP: July 21st-25th

$225.00

Kids Classes Form

Child's Name *

First Name

Last Name

Child's Age (at time of camp session) *

List any medical conditions your child has that staff should be aware of *

Primary Contact/Legal Guardian *

First Name

Last Name

Phone *

Email *

Emergency Contact/Secondary Guardian *

First Name

Last Name

Phone *

Individuals authorized to pick up Child * (other than Primary & Secondary Contacts/Guardians)

Release of Liability *

The following is my digital signature that acts to hereby now prospectively waive and relinquish, to the fullest extent recognized by Missouri and/or Kansas law at the time of any future injury or loss, any right or cause of legal action I and/or my ward may ever in the future have against Red Star II LLC, the Belger Arts Centers, or Belger Carriage Service, Inc. (THE ORGANIZATIONS), its employees, officers and agents, even if a cause of such injury or loss is alleged to be negligence by an employee or member of THE ORGANIZATIONS or any person acting on behalf of those aforementioned organizations; and further, the undersigned agrees hereby now to indemnify THE ORGANIZATIONS and/or any member thereof and/or any person acting on behalf thereof in the event that any damages are assessed against THE ORGANIZATIONS and/or any member thereof and/or any person acting on behalf thereof, despite the terms of this Agreement.

I have read and accept the Release of Liability.

Image Release * The following is my digital signature hereby allowing Red Star II LLC and the Belger Arts Center to take photographs of me and/or my artwork to be used for public relations and archival purposes only.

I accept

How did you hear about this programming? *