Camp Registration: Winter Break 2019/20

Name of Parent or Guardian

Email

Name of Camper

Name of Camper
Please list additional siblings here.

Current School(s)

Age(s) of Camper(s)
List ages of additional campers respectively.

Address

Select camp:
All other days of winter camp are SOLD OUT

Camp Registrations are closed at this time‎

How did you hear about KMAC Camps?

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Emergency Contact 1

Relation to Camper

Phone

Emergency Contact 2

Relation to Camper

Phone

Physician

Phone

List any allergies or dietary restrictions your child has:

List any special instructions in the case of a reaction:

Does your child carry an EpiPen or any other medications or treatments?

Please list and provide instruction on administering if needed:

List any other medical issues, needs or additional information we should be aware of and procedures for handling if needed:

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KMAC Camp Permission Terms

I hereby grant permission for my child to use all art supplies and equipment and participate in all activities during the 2019/20 KMAC Art Camps.

I hereby grant permission for KMAC Museum personnel to take whatever step necessary to obtain emergency medical care if warranted. These steps may include but are not limited to attempting to contact a parent, guardian or any of the persons listed on the registration form as contacts. If the above mentioned cannot be contacted, KMAC Museum personnel will call a physician or, if necessary, call an ambulance. Any expenses incurred while enlisting the help of medical personnel as listed above will be borne by the child's family.

I hereby grant permission for my child to be included in the documentation of the camp through the use of photography, video and printed materials as is deemed appropriate by KMAC Museum. The forms of documentation may include but are not limited to promotional literature published by KMAC Museum, articles and/or photographs to be published in area newspapers, and filmed segments to be aired on local television stations. Students’ names may or may not be published in such.

It is agreed that KMAC Museum and staff assume no liability for injuries sustained as a result of participation in the 2019/20 KMAC Art Camp.

I hereby grant permission for my child to accompany KMAC Museum staff on field trip and lunch trip outings within walking distance of the KMAC Museum in downtown Louisville.

In consideration for my child's opportunity to participate in the 2019/20 KMAC Art Camp, I hereby agree to release, hold harmless and indemnify KMAC Museum and its employees from all claims, damages, or other liabilities for injuries to my child which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by KMAC Museum or its employees.

Digital Signature of Parent or Guardian

Clear