If you will be dropping off your child, please list a phone number where we can reach incase of emergency.

This will help us in planning suitable materials for your child.

As a parent or guardian of the registered child, I hereby consent to remain on the premises of Radiate Art Space with above child(ren) during the session. I understand that the Town of Richmond, Radiate Art Space, the directors and volunteers assume no responsibility for loss, theft, or damage, or for the personal injury of any individual attending Radiate Art Space.

I consent to the use of photographs taken during sessions at Radiate Art Space for publicity, presentation, and promotional purposes. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

Please describe any additional information you would like us to know about your child.

I hereby represent that this child(ren) is in good health, and that I have identified all medical conditions associated with this child(ren), and that I have adequately informed Radiate personnel of any special instructions regarding this child. I certify that I have adequate insurance to cover any injury or damage the child(ren) may suffer while participating, or else I agree to bear the costs of such injury or damage myself. I understand that every effort will be made to contact the parent/guardian in case of an emergency. I hereby authorize staff at Radiate Art Space to obtain emergency medical care for my child(ren). In addition, if my child(ren) requires emergency medical transportation, I authorize my child to be transported.