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Authorization and Release Form
Participant Information (Please complete a separate form for each child):
Child's Shirt Size
Grade Level as of Fall 2023
Does your child need a scholarship? Choose a code to use a checkout:
*Use this code as a coupon when you checkout online
Parent/Guardian Contact Information:
Authorized persons who may be contacted or may pick up your child in case of emergency:
Permission for enrollment and release of Creston Arts from liability:

I give my child permission to participate in Creston:Arts Summer Art Camp. Therefore, in exchange for Creston:Arts allowing my child to participate in Creston:Arts Summer Art Camp activities, I understand and expressly acknowledge that I release Creston:Arts (including Creston:Arts Summer Art Camp staff, instructors and volunteer mentors) from all liability for any injury, loss or damage connected in any way whatsoever to participation in Creston:Arts Summer Art Camp activities. I understand that this release includes any claims based on negligence, action or inaction of the parties listed above. I have read and am voluntarily signing this authorization and release. I hereby grant permission for my child to participate in all activities provided by Creston:Arts Summer Art Camp.

Authorization for emergency medical treatment:

If my child should become ill or injured during Creston:Arts Summer Art Camp activities, I understand that Creston:Arts Summer Art Camp will I) contact me immediately or 2) contact the person(s) I have designated in case I cannot be reached. Should Creston:Arts Summer Art Camp staff be unable to reach me or the person(s) I have designated, Creston:Arts Summer Art Camp staff are authorized to contact my physician or arrange for immediate medical treatment to ensure the health and safety of my child. I accept responsibility for payment of medical services provided.

Photo/Video Release:

I grant permission to Creston:Arts to use photographs and videotapes taken of my child for Creston:Arts publication and promotional purposes.

Medical and other information:
Which week(s) of Art Camp will your child attend?



Thanks for submitting!

To pay with a check, please submit in person or mail to the
Creston Arts Center, 411 W. Adams St. Creston, IA 50801

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