Children’s Program Waiver Children's Program Waiver "*" indicates required fields Child's Name* Name Email* Parent or Guardian* Name Relationship to the Child* WaiverAs parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend The Portsmouth Arts Guild, its officers, directors, employee, instructors, from any claim arising from or in connection with my child attending this Portsmouth Arts Guild program, in connection with any illness or injury or cost of medical treatment in connection therewith. Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Any medical concerns have been listed on the Registration Form. Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor, in the event of an emergency, if you are unable to reach me at the above numbers contact Emergency Contact other than Above (enter Same if applicable)* Phone*ResponsibilityPAG is not responsible for preventing the spread of Covid 19. Vaccinations, face masks, and other protections are the responsibility of the undersigned guardian.Signature Typing your name signifies your electronic signature. Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.