21 East Main Street

Annville, PA 17003

Hosting Scheduled Programming

1669 East Derry Road

Hershey, PA 17033

Hosting Regular Hours of Operation

Phone: (717) 685 - 1681

E-mail: info@SplatFamilyArt.com

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Only one waiver needs to be completed, regardless of the amount of programming the individuals listed are attending. A parent/guardian waiver signed consent is required for participation.

Thank you!

SPLAT STUDIO

RELEASE AND WAIVER OF LIABILITY

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As a requirement for being allowed to enter SPLAT Studio   and/or participate in any party and/or art program at SPLAT Studio   , the undersigned, on his or her behalf, and on behalf of the

Participant(s) identified below, acknowledges, understands, appreciates, and agrees to the following.

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I represent that I am the parent or legal guardian of the Participant(s) named below.  I acknowledge and understand that there are risks associated with participation at SPLAT Studio's   art activities including but not limited to soiled and staining clothing, scrapes, cuts, bumps, burns, allergies and contact dermatitis.  I, for myself and the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to other Participant(s), which I willingly assume.  I agree to the Participant(s) named and I shall comply with all stated and customary terms, posted safety signs, rules (no photography), and verbal instructions as conditions for participation in any party or program at SPLAT   .

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I agree to the use of photos taken by SPLAT Studio   , of the Participant(s), in promotional materials including the SPLAT    website and Facebook Page.  I, for myself, the Participant(s) named, our heirs, assigns, representatives, and next of kin agree to hold harmless and indemnify the owner of SPLAT Studio    , SPLAT    employees and volunteers from any and all injuries, liabilities or damages arising from participation.

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I additionally agree to indemnify the owner of SPLAT Studio   , SPLAT    employees and volunteers for any defense cost or expense arising from any and all claims, injuries, liabilities or damages arising from participation.  I am legally competent to understand and complete this agreement.  I hereby execute this agreement without coercion.

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I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE.  IT IS MY INTENTION TO EXEMPT AND RELIEVE SPLAT STUDIO    FROM LIABILITY FOR PERSONAL INJURY OR PROPERTY DAMAGE CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

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PARENTS OR GUARDIAN'S LIST ALL CHILDREN UNDER 18 BY NAME AND AGE

Please place children's names on separate lines and follow with their age in parenthesis.  If you have more than four children to list on the waiver, please place more than one name with corresponding ages in each box and separate with a comma to avoid confusion.  See below for an example. Thank you.

Example: Andrew (7), Grayson (11)