Puppies & Ponies Summer Camp: August 19th - 23rd at Benjamin Tree Farm

Liability Waiver

As the parent/legal guardian of this above named child, I request that in my absence the above named child be admitted to any hospital or medical facility for diagnosis and treatment in the event of an accident, injury, sickness, etc. I request and authorize physicians, nurses, dentists, and staff to perform any diagnostic procedures, treatment procedures, and operative procedures to the above named individual in the event of an accident, injury, sickness, etc. I have not been given any guarantee as to the result of any treatment if performed on the above named individual. I hereby accept any financial responsibility for any and all medical treatment necessary to be administered to the above named child in the event of an accident, injury, sickness, etc. Any representative of the following organization is designated to act in by behalf until I have been contacted: ARTSHINE INC.

I have read and understood the information provided by ARTSHINE regarding camp. I waive any right to claim against ARTSHINE’S owners, staff and teachers in the event of an accident, injury, or loss of personal items. I understand that I am committing to participation in ARTSHINE camp and reserving a place in class for the designated session. ARTSHINE does not offer refunds for tuition paid but will provide a credit towards future ARTSHINE program when warranted. I understand it is my responsibility to pick up my child from the designated location at the designated times unless other arrangements have been made. I authorize the release of my child’s artwork and photo for display purposes by ARTSHINE.

Alternative Individual for Pick-up of Camper

As the parent/legal guardian of the registered child, you will need to authorize an alternative individual or individuals to pick-up the registered child should you not be available. You will specifiy the names of these individuals using the form on this page. Anyone not specified by you will not be permitted to pick-up the registered child. Any alternative individuals will be required to show proof of government issued photo identification.