Consent

CONSENT FORM

PLEASE COMPLETE THE FORM BELOW

* Indicates required field

Name of Student *

First

Last

Students Date of Birth *

Parents or Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Please list any allergies or special considerations we may need to be aware of: *

Emergency Contact: First Name *

Emergency Contact: Last Name *

Emergency Contact: Phone *

Parental Consent (required for students under 18)
As guardian and/or parent, I understand that I assume full responsibility for my child’s arrival and departure to and from FireFusion Studio. I understand that FireFusion Studio shall bear no responsibility for the means by which my child arrives at or departs.

Parental Consent *

I Agree

Liability Agreement
In consideration for being allowed to participate in this Activity, I release from liability and waive my right to any legal action to FireFusion Studio LLC, their owner or employees, contractors, volunteers and students from any and all claims, including negligence, resulting in any physical injury, illness (including death) or economic loss I may suffer or which may result from my participation in this Activity, travel to and from the Activity, or any events incidental to this Activity.

Liability Agreement *

I Agree

Photography Release
I consent to and authorize the use and reproduction by FireFusion Studio or anyone authorized by FireFusion Studio of any and all photographs that have been taken of me (if Student) or my child without compensation to me. All photo images are owned by FireFusion Studio. FireFusion Studio reserves the right to use these photographs in any of its print or electronic publications. I hereby acknowledge that I have read and understood the terms of this release.

Photography Release *

I Agree

Right to Refuse Service
I understand that FireFusion Studio reserves the right to dismiss me from this Activity and all association with FireFusion Studio for reasons such as, but not limited to, signs of illness, disruptive or unsafe behavior, behavior unsuitable for the comfort of the classroom environment, or poor performance at the sole discretion of FireFusion Studio.

Right to Refuse Service *

I Agree

Covid-19
I waive all rights to any legal action against FireFusion Studio in the event of injury, illness, damages, loss of personal property not caused by or resulting from the negligence of the owner or attendees in the studio. Preventative measures will be practiced to reduce the spread of COVID-19 by limiting the number of people in the studio to half our normal capacity (or less), increased cleaning and disinfection of area and equipment, and refusing admission to anyone appearing to not be feeling well.

Covid-19 *

I Agree

Submit

CONSENT FORM

​PLEASE COMPLETE THE FORM BELOW

PLEASE COMPLETE THE FORM BELOW