Does the student have any health or personal concerns/allergies our staff should be aware of:
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If you answered "Yes" to the question above please explain:
Being a parent or legal guardian of the above named minor, I do hereby appoint the Artists Association of Nantucket or the following individuals: (Adult students please list emergency contact also)
1) Emergency contact name
phone
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2)
Emergency contact name
phone
3)
Emergency contact name
phone
to act in my behalf in authorizing emergency medical, dental or surgical care and hospitalization for the above named minor or adult in the event that I cannot be reached. This document will be presented to a physician, dentist, or appropriate hospital representative at such time as emergency medical, dental, or surgical care or hospitalization may be required.
POLICY: The undersigned hereby agrees to indemnify and hold harmless
the Artists Association of Nantucket, its agents and employees from any
and all liability, loss, damage, expense, causes of action, suits,
claims or judgments for injury to the above mentioned child(ren) or
adult(s) or the property thereof resulting from or arising out of the
participation of the above mentioned person as an Artists Association
of Nantucket art student(s), and shall at his/her own cost and expenses
defend any and all actions or suits which may be brought against the
Artists Association of Nantucket, either alone or in conjunction with
others, upon any such liability, claim, or claims and shall satisfy,
pay and discharge any and all judgments, and fines that may be
recovered against the Artists Association of Nantucket in any such
action or suit, provided, however that the Artists Association of
Nantucket shall give the undersigned written notice of any such claim
or demand.
Parent or guardian name: (please type in)
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Please type in your initials to indicate that the provided information above is correct and you have read, understood, and agreed to the Policy statement above:
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