Mythic Creatures: Fact or Fiction?

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Monday, December 30, 2019

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Witte Museum Camp $390.00
Witte Museum Camp Member $340.00

Child's Full NameRequired

Child's Date of BirthRequired

Child Shirt SizeRequired

Parent/Guardian Full NameRequired

NameRequired

Address:Required

City

CountryRequired

State or Province

Zip Code

Parent/Guardian Home PhoneRequired

Parent/Guardian Cell PhoneRequired

Parent/Guardian emailRequired

Does your child wear glasses or contact lenses?Required

Does your child have any known allergies?Required

If yes, please list known allergies:

Does your child have any physical or behavioral conditions that could restrict activities or require special accomodation? (Examples: epilepsy, diabetes, ADHD, ASD, etc.)Required

If yes, please explain:

NOTE: Museum staff is not allowed to administer any medication. If your child needs medication during the program, you or someone you designate in writing must administer that medication. Selecting "Yes" signifies your consent that you recieved this notice.Required

Emergency Contact 1, Name and Phone NumberRequired

Emergency Contact 2, Name and Phone NumberRequired

Are there any other adults that you would like to receive information about your child's participation in the Witte Museum Camp? If so, please add them here. Include full name and email address.

Photo/Image Waiver and Release: I authorize and give consent to the usage of photographs or other images of my child by the Witte Museum, or any of its affiliated organizations and sponsors, for publicity, advertising, or any other legitimate business purposes.Required

In consideration of my child being able to participate in the Witte Museum Camp program sponsored by the Witte Museum, I, the undersigned parent, binding my heirs, executors, administrators, estate, and assigns, do hereby release and agree not to hold liable the Witte Museum, its officers, agents, employees and volunteers, for any and all actions, claims, demands, costs, or damages as a result of property damage or personal injuries sustained by my said child, his /her or my property, arising from or resulting from any act of omission, negligent or otherwise, of said the Witte Museum, its officers, agents, employees, and volunteers or any other person or any other participant in the program while participating in the said activity or while traveling to and from place at which such activity will be conducted.

In the event the Witte Museum or a volunteer provides transportation for my child, this Waiver and Release Form shall extend to and release the volunteer driver or the Witte Museum employee driver from any and all liability aforesaid.

I do further with the same intent bind my heirs, executors, administrators, estate, and assigns, to hereby release and agree to hold harmless any landholder or lessee of land or property onto which my child may go as part of the activities of the Witte Museum Camp program from any and all actions, causes of action, claims, demands costs or damages or my property, arising from or resulting from any act of omission of the owner or lessee or any defect in the promises, known or unknown, or the owner or lessee.

Consent is hereby given for the applicant to attend the Witte Museum Camp program and permission is given for all emergency medical treatments, operation, or anesthesia, which might become necessary.
By signing electronically, with initial and date, you agree to all that is above. Required

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Options for Programs: $340.00 - $390.00

Witte Museum Camp $390.00

Witte Museum Camp Member $340.00

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Witte Museum Camp $390.00

Witte Museum Camp Member $340.00

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