Summer Camp June 3-Sept. 2

Select the number of campers and dates your camper is attending, and select full day or half day. Exp: *Total Number of Campers: 2 *1st date: 3/14 *Half Day: 1

Skip this section if registering for 1 week at time

Section below is for purchasing Summer Camp Weeks Only

When attending a week at a time choose the dates below

In this field enter the amount of camp weeks in total. Exp: 3 campers in total attending 1 week. ENTER: purchasing 1 week

Eye Heart Art Waiver

I hereby waive, release and discharge any and all claims and damages for personal injury, death, or property damage which I, or my minor children, may sustain or which may occur as a result of my own participation, or that of my minor children, in Eye Heart Art classes and other activities. I further understand and agree that:

1.This release is intended to discharge in advance Eye Heart Art, its officers, employees and agents from and against any and all liability, with my participation or my minor children’s participation in Eye Heart Art activities; 2. Such classes and activities may be of a hazardous, strenuous, and/or physical nature, and participation in said activities may result in injury, death or property damage; 3. Knowing the risk involved, nevertheless, I voluntarily request permission for myself or my minor child to participate in said activities; 4. I hereby assume any and all risks of injury, death or property damage and to release and hold harmless Eye Heart Art, its officers, employees & agents, except for their sole negligence or intentional acts; 5. This waiver, release and assumption of risk is binding on me and my heirs and assigns; 6. I will indemnify and hold Eye Heart Art harmless from any loss, liability, damage, cost or expense, including litigation, which it may incur as a result of any injury and/or property damage which myself or my minor children may sustain while participating in said activities; 7. I will compensate any loss, damage, or cost Eye Heart Art may incur if any litigation arises due to any claim made by myself, said minors, or by anyone on said minor’s behalf; 8. In the event that said minor requires medical or surgical treatment while under the supervision of Eye Heart Art personnel in connection with said activities, such supervisor may authorize treatment; 9. I will pay all medical, hospital, or other expenses which I or my minor children may incur as a result of such treatment; 10. Activities are not child care as defined by the State of California; 11. Eye Heart Art is not responsible for unattended children on the premises before or after classes for which they are enrolled; 12. I expressly allow, and hereby waive any objection to, Eye Heart Art photographing and/or videotaping of me and/or my minor children when I and/or my minor children are participating in Eye Heart Art programs; 13. I understand and agree that all photographs and videotapes will remain the property of Eye Heart Art, and that Eye Heart Art may use such photographs or videotapes for archival and promotional purposes, including their use in Eye Heart Art catalogs, brochures, other printed materials, and in Eye Heart Arts online web pages. I certify that I have custody or am the legal guardian of said minors by court order, and that I and my minor children are physically able to participate in the described activities. I have carefully read this Waiver of Liability, Medical Release, Photography/Videotape Release and Indemnification Agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Eye Heart Art, and that I sign it of my own free will. Eye Heart Art may accept future phone, mail, online, or in-person registrations under these provisions. Late Fees Eye Heart Art fees are due at the time of registration. Students may not participate unless fees have been paid. A $5 administration fee will be charged for each class registration received more than one week after the beginning of class. Registrations are considered final 5 business days before the first class, and no refunds will be given after this time. Exceptions to this policy may be granted in cases of documented family or medical emergency. Eye Heart Art does not pro-rate fees due to planned absences, minor illnesses, vacation schedules, or other conflicts. Classes are not refunded or pro-rated due to failure to attend. If a pro-rated or drop-in payment is approved by the instructor, a $5 administration fee will be applied to each drop-in or pro-rated class in a session. Participation Policies Eye Heart Art is not responsible for unattended children on the premises. We do not assume responsibility if your child is dropped off early or picked up late. Please come into the building to see that your child gets to class. Eye Heart Art is responsible only for registered students. Parents are responsible for children brought onto the premises who are not registered in our classes. I also understand the Refund and Late Fee Policies, and the potential consequences thereof, set forth by Eye Heart Art and agree to such terms.

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