HOME / SCHOOL OF THE ARTS / CHILDREN'S CLASS RELEASE FORM

Please fill out the below student release form for children’s classes in which your child will participate. Thank you! If you would like to discuss the classes in more depth, or for any questions regarding classes, please contact the Athenaeum School of the Arts Director Maura Walters at mwalters@ljathenaeum.org or (858) 454-5872.

Release Form for Children’s Classes

Liability Release

Athenaeum Music & Arts Library (Library Association of La Jolla) a California non-profit corporation (herein collectively referred to as “AMAL”) provides art classes, including field trips by foot etc. herein called “Activities.” In consideration of being permitted to participate in any way in any “Activity”: I, for myself, as Parent/Guardian of Participant, and/or as Participant: 1) ACKNOWLEDGE, agree, and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2) HEREBY RELEASE, DISCHARGE, AND CONVENANT NOT TO SUE AMAL, as well as the officers, directors, agents, employees and assigns of each, and the AMAL teachers, officials, administrators, members, volunteers, participants, sponsors, advertisers, and if applicable, owners and leasers of premises on which the Activity takes place, and any other party indemnified and held harmless by AMAL (each considered one of the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEDGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS, NEGLIGENT SECURITY, AND RECREATIONAL OPERATIONS AND ACTIVITIES; I FURTHER AGREE, that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the “RELEASEES”, I WILL IDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss liability, damage or cost which any may incur as the result of such a claim.

Medical Release

I grant to act as guardians/spokesmen in granting permission for emergency treatment/hospitalization (including anesthesia) if necessary for the Participant en route to or from or at the site of any “Activity” or hospital or other medical facility. I understand that should a health emergency arise, I will be attempted to be notified, but that if I cannot be reached by telephone, such medical treatment as deemed necessary by competent medical personnel is authorized. I further understand that I will be responsible for payment of such medical procedures.

Photo/Video Release

I hereby authorize AMAL to allow the reproduction, dissemination, and/or publication of Participant’s and likeness for media coverage, public relations, or any other purpose, which may involve the use of photographs, film, and/or video recording. This is to be done in conjunction with my participation in an “Activity” or event and I understand and agree that I may neither pay a fee to receive individual promotional consideration, nor will I receive any payment for the possible commercial use of Participants likeness.

Code of Conduct

The Athenaeum School of the Arts strives to provide an environment conducive to learning. We expect students to care about themselves, each other, and the environment around them by exhibiting integrity, compassion, a good attitude, respect, and effort. Students are also expected to follow the classroom guidelines as assigned by their individual teachers. The Athenaeum School of the Arts reserves the absolute right to dis-enroll a student at any time for any reason. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

Today's Date

MM

DD

YYYY

Name of Participant/Child 1

First Name

Last Name

Date of Birth of Participant/Child 1

MM

DD

YYYY

Name of Participant/Child 2

(optional)

First Name

Last Name

Date of Birth of Participant/Child 2

(optional)

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Name of Parent/Guardian

First Name

Last Name

Parent/Guardian Cell Phone #1

(###)

###

####

Parent/Guardian Cell Phone #2

(optional)

(###)

###

####

Donate to the Scholarship Fund

Thank you to our students!

Children’s Class Release Form

HOME / SCHOOL OF THE ARTS / CHILDREN'S CLASS RELEASE FORM

Release Form for Children’s Classes

Thank you to our students!

Athenaeum Music & Arts Library

Library Hours

Athenaeum Art Center

AAC Hours

Follow us on Instagram!