Participant Information

Name

Sex

Date of Birth


Parents Names (if a minor)

Mother

Father

Address

Street

City

State

Postal Code

Contact Phone Numbers

Mother's Primary Contact

Mother's Seconday Contact

Father's Primary Contact

Father's Secondary Contact

Email

Email


Medical Information

Allergies

Family Physician

Physician's Phone

Physician's Address

Street

City

State

Postal Code


Kindred Art and Folk Institue staff members make every effort to conduct safe programs, to orient and support children, and to inform families of inherent risks. Some activities may involve risks that children do not routinely encounter at home. Risk management is an essential element of all the activities offered. While we anticipate that these efforts will ensure the wellbeing of each child, we are also aware that it is neither possible to foresee every contingency nor to eliminate all risk.

I understand and certify that my child’s participation in the Kindred Art and Folk Institute activities are completely voluntary, and that I have become familiar with the sessions in which my child may participate, as described.