Washington Liability Release Form 2Washington Liability Release Form 2Washington Liability Release Form 2
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Form 3

Your Child’s Name

Liability release Form
I agree for my child to participate in the 2012 SAM Camp, and hereby release the Seattle
Art Museum, its trustees, owners, instructors and employees from liability for any injury my
child may suffer as a result of his/her participation.

I agree that all information included on this form is true to best of my knowledge.

Parent/Guardian Signature

Date

Please return this completed form when you register your child. You may fax to 206.654.3135
or email signed copied in PDF to [email protected]
I agree that all information included in this form is true to best of my knowledge.

Parent/Guardian Signature

Date

Seattle Art Museum
1300 First Avenue
Seattle, WA 98101-2003

seattleartmuseum.org
Fax: 206.654.3135
[email protected]

Form 2

Your Child’s Name

Medical Information Form
Doctor to contact in case of medical emergency
Clinic/Hospital name
Insurance (if any)

Doctor name

Address

City

Phone

Medic