Student Information

So we can provide a fun and safe experience for your students please fill out the form below.

 
 
Child # 1 Name
Child # 1 Name
Child #2 Name
Child #2 Name
Parent Name *
Parent Name
Parent Phone *
Parent Phone
Address *
Address
How will your child(ren) be signed out *
Name of adult picking up child(ren) *
Name of adult picking up child(ren)
Phone of adult picking up child(ren) *
Phone of adult picking up child(ren)
Name of emergency contact *
Name of emergency contact
Phone of emergency contact *
Phone of emergency contact
I have read and approve the below Liability Waiver Form for all my children listed above
I have read and approve the below Liability Waiver Form for all my children listed above
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (“AGREEMENT”) I hereby certify my child to be in good health and able to participate in DesignX camp activities. I understand that due to the nature of the subject being taught, sharp implements like pins and needles and tools like sewing machines, irons, scissors, hammers etc. may be used. I further understand that during the daily recess/snack break children may be allowed to play outdoors in a supervised setting. While DesignX will make every attempt to provide the above in a safe and appropriate way, I fully recognize that these activities involve the inherent risk of serious bodily injury and that there may be other risks either not known to me or readily foreseeable at this time. I fully accept and assume all such risks and responsibility for losses, cost and damages I incur as a result of my child’s participation in the Activity. I hereby release, discharge and covenant not to sue DesignX, its respective administrators, directors, agents, officers, volunteers and employees, other participants and sponsors, advertisers and if applicable owners and leasers of premises on which the Activity takes place (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save, and hold harmless each of the releases from any loss, liability, damage or cost, which any may incur as a result of such a claim. I have read the RELEASE AND WAIVER OF LAIBLITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by signing it and have signed it freely without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance notwithstanding, shall continue in full force and effect, AND I, the minor’s parent and or/legal guardian, understand the nature of the above referenced activities and the Minor’s experience and capabilities and believe the minor to be qualified to participate in such activity. I hereby release, discharge, convenent not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releases from all lability, claims, demands, losses or damages, on the minors’ s account caused or alleged to have been caused in whole or in part by the negligence of the Releases or otherwise, including negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minors behalf make a claim against any of the above Releases, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releases for any litigation expenses, attorney fees, loss lability, damage or cost any Releasee may incur as the result of any such claim.
May we have permission to use your child(ren)'s photos in promotional materials? *