Other Authorized people to Pick-up
These people will be required to show ID upon arrival. Please list each on a separate line and include
First and Last Name/Relationship to child(ren)
Please give description of condition including any allergies/sensitivities. Please describe the severity and action plan for each condition or allergy.
Emergency Allergic Reaction Medication Administration (only needed if your child requires an Epi Pen)
I, the Parent/Guardian, do hereby authorize and allow artSPARK Creative Studio, all of its employees, officers, members, managers, agents and other affiliated persons or entities ("artSPARK") to administer emergency anaphylactic shock medication to my child listed on this form for the purpose of alleviating the symptoms of an allergic reaction. I, for other good and valuable consideration, hereby fully and forever waive, relinquish, release and discharge artSPARK and all of its employees, officers, members, managers, agents and other affiliated persons or entities, from any and all claims, demands, and causes of action this emergency allergic reaction medication administration form and waiver. I agree not to sue artSPARK or any of its employees, officers, members, managers, agents or other affiliated persons or entities as a result of any claim, injury or event that may occur as a result of this agreement. I have provided artSPARK with the emergency medication that my child, Student, requires in the event of anaphylactic shock. I have provided this emergency medication to artSPARK and have advised artSPARK on the medication’s use and administration according to the terms of the medication’s instructions and disclaimers.
I Agree to the above statement
I request that artSPARK maintain this medication in a refrigerated environment per the terms of the manufacturer’s recommendations as provided in the medication’s instructions and disclaimers.
Please list any nicknames, learning differences, fears, quirks, or things you want us to be aware of. i.e. Jackson--Jack auditory processing challenges and fear of loud noises.
Previous art experience?
Please briefly describe any previous art experience good or bad in other schools or programs