​COMBINED PARTICIPATION WAIVER…

 

MEDIA RELEASE & EMERGENCY AUTHORIZATION

 

​

 

For Minor / Dependent Participant

(Electronic Signature Friendly – Florida)

 

​

​

PARTICIPANT INFORMATION

 

Child’s Name: _________________________________________________

Date of Birth: _____________

​

Parent/Guardian Name: _________________________________________
 

Phone: _______________     Email: __________________________________________________________

 

1. PARTICIPATION & LIABILITY RELEASE

​

I am the parent or legal guardian of the child named above. I voluntarily give permission for my child to participate in program activities.

I understand that activities may involve normal risks, including physical movement, art materials, group activities, and community or school‑related events.

To the fullest extent permitted by Florida law, I release and hold harmless The Arts Corner / The Arts Corner KIDZ Network Inc., (TAC), a nonprofit arts and education organization (501C3), its employees, volunteers, instructors, and representatives from claims or injuries arising from participation, except when caused by gross negligence or intentional misconduct.

 

2. PHOTO & MEDIA PERMISSION (OPTIONAL)

​

I give permission for my child to be photographed or recorded during program activities. Images or recordings may be used for lawful purposes such as education, promotion, websites, newsletters, social media, or grant reporting.

​

☐ I DO NOT give permission for my child’s photo/video to be used.
(Checking this box will not affect participation.)

​

I understand no payment will be provided by TAC and that materials may be edited or used without prior review.

 

3. EMERGENCY MEDICAL AUTHORIZATION

​

If I cannot be reached in an emergency, I authorize program staff to obtain emergency medical care for my child, including transportation if needed.

I understand that I am responsible for all medical expenses.

Allergies / Medical Conditions / Special Needs or concerns:

 

4. GENERAL TERMS

 

• I am at least 18 years old and legally authorized to sign

• I am signing voluntarily and without pressure

• This agreement is governed by Florida law

• Venue for any legal matter shall be in the state of Florida

• If any part is invalid, the rest remains in effect

• This form represents the complete agreement

 

EMERGENCY CONTACTS

​

Emergency Contact #1
Name: _________________________________________________________

Relationship: ____________________________________________________

Phone: _______________________________

 

Emergency Contact #2
Name: _________________________________________________________

Relationship: ____________________________________________________

Phone: _______________________________

 

 

​​

​

​

 

Parent/Guardian (Electronic) Signature: ________________________________

 

Date: ___________________

​

​​