Nature-Arts Preschool

59th Street at Central Park West

New York, NY 10024
(212) 769-5580
natural-arts-preschool@gmail.com
www.natural-artspreschool.com
PARENT/LEGAL GUARDIAN CONSENT AND LIABILITY FORM
The following information must be read, understood, and signed by the [parent (s) and/or legal guardian(s) of
the applicant

ASSUMPTION OF RISK AND RELEASE OF LIABILITY

CHILDS NAME:________________________________
I give permission for my child to participate in Natural-Arts Preschool (NAP). I understand that the
Natural-Arts Preschool provides opportunities for children to visit parks, museums, and fieldtrips. These
activities are not without risk or possible injury, and that NAP cannot guarantee that my child will remain
free of injury. I acknowledge that the following describes some, but not all of the risks of my child
participating in the Natural Arts Preschool. I nonetheless wish to have my child participate in the Natural
Arts School and ASSUME the RISK of participating. I, for myself and any minor children for whom I am
parent, legal guardian or otherwise responsible, any heirs, personal representatives or assigns, agree to
RELEASE from LIABILITY, INDEMNIFY and HOLD HARMLESS the Natural-Arts Preschool and
their employees and agents from any and all claims and/or causes of action arising out of and related to
any injury, loss, penalties, damage, settlement, costs or other expenses or liabilities that occur as a result
of my childs participation in the Natural-Arts Preschool.
I have read the Assumption of Risk and Release of Liability. I understand that I am expressing my
intent to waive valuable legal rights including any and all rights I may have against those named above.
Parent/Guardian Signature: _________________________________ Date: ____________________
I have read the Assumption of Risk and Release of Liability and do not agree with the above.
Parent/Guardian Signature: _____________________________________________ Date:
____________________
HEALTH/MEDICAL EMERGENCY
I understand that my child must be healthy and reasonably fit in order to safely participate in Preschool
activities and that I will inform the office and educator(s) of any medication, ailment, condition, or injury
that may affect his/her ability to participate safely. I understand that as a parent, if I believe it is necessary
to limit my childs activities to a great extent, the Natural Arts Preschool may not be able to accommodate
my child in this program and that I will be informed of this decision as soon as possible upon receipt by
NAP of this completed consent form. If an injury or other condition occurs or arises, I hereby give
permission to NAP to seek emergency treatment. I agree to the release of any record necessary for
treatment, referral, billing or insurance purposes. I understand that I am financially responsible for
charges, and acknowledge that the NAP does not carry any health insurance for my child.
I have read the above and agree to the terms and conditions
Parent/Guardian Signature: _______________________________ Date: ________________________
I have read the above and do not agree to the terms and conditions
Parent/Guardian Signature: _____________________________________________ Date:
___________________
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PRESCHOOL EVALUATION PERMISSION
I grant permission to the Natural Arts Preschool to use participant information regarding my child,
identified only through a code number or first name, in reports about the program to AMNH funders.
I grant permission to the Natural Arts Preschool for my child to take part in evaluation of the program
conducted by ENAP staff or external evaluators under the supervision of NAP staff. Program evaluations
do not include evaluation of student performance.
I have read the above and agree to the terms and conditions
Parent/Guardian Signature: ____________________________________________Date:
__________________
I have read the above and do not agree to the terms and conditions
Parent/Guardian Signature: ____________________________________________Date:
__________________
PUBLICITY/IMAGE/VOICE/NAME PERMISSION
I grant to NAP permission to take videos and/or photographs of my child participating in the program,
and agree NAP may edit, publish, broadcast and web publish the videos and/or photographs along with
my childs first name only in NAP educational and promotional material. I further grant NAP permission
to sublicense use of my childs photo/video to third parties for educational or non-commercial purposes,
including but not limited to articles in scientific or educational journals, magazines or associated
websites. The latter will only be done in the context of highlighting NAP programming. I also grant NAP
permission to publish any product produced by my child during the class along with my childs first
name.
I have read the above and agree to the terms and conditions
Parent/Guardian Signature: ____________________________________________Date:
__________________
I have read the above and do not agree to the terms and conditions
Parent/Guardian Signature: ____________________________________________Date:
__________________