Youth Academy Authorizations Online : Scottsdale Artists' School

Date*

Class / Camp Name*

Additional Class / Camp

Student Name*

First Last

Birthday*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Name*

First Last

Phone*

Email*

Alternate Contact

Alternate Phone

Emergency Contact & Phone Number*

Any behavior or medical issues we need to be aware of (please note that Exceptional Student Services are not available)

Medical conditions

Drug/Food Allergy

Other Allergies

Health Insurance Info

By signing this agreement, I/We the undersigned parent(s)/guardian(s) of this youth do hereby authorize Scottsdale Artists’ School (instructors and staff) to make any and all decisions and to authorize and consent to, any and all emergency medical care deemed necessary, to be rendered to the above named youth for their care and safety. The undersigned understands that reasonable and diligent efforts will be made to locate or contact the undersigned in an effort to obtain consent to all medical treatment unless delay in such treatment would be unwise. The undersigned takes full responsibility for any financial cost which may be incurred for the care of the above named youth.

Signature*

By signing this agreement, I/We the undersigned parent(s)/guardian(s) of this youth do understand that Scottsdale Artists’ School (instructors and staff) are acting only as agents and shall not be responsible or liable for any injury/ accident/ illness, which may occur on site or within the duration of class time. Please be aware that we must be able to reach you in the case of an emergency. All classes will be conducted with utmost care in a safe learning environment. Please make arrangements to drop off and pick up your child on time. No child will be released without proper authorization from the parent/ guardian in advance. For their safety, each day every child must be signed in and out.

Signature*

Printed Name for the parent(s)/guardian(s) signature above*

First Last

I hereby declare that the signature above is my legal signature and I am the parent/guardian of the youth on this form.