Studio49 Adult Consent Waiver
Studio Name: Studio49______
Studio Address: _____129 S Main St. Livingston, MT_______
Email: _________project49mt@gmail.com_______________
Participant Information (over 18)
Full Name: ___________________________________
Age: ______
Address: ___________________________________
City, State, ZIP: ___________________________________
Emergency Contact
Name: ___________________________________
Relationship: ___________________________________
Phone Number: ___________________________________
Consent and Acknowledgment
I understand and acknowledge the following:
Art Materials: I understand that the studio may use various art materials (e.g., paints, glues, clays) that can be messy or mildly hazardous if misused.
Health & Allergies: I confirm that I have informed the studio of any relevant health concerns or allergies.
List any known allergies or medical conditions: ____________________________
Medications (if any): ____________________________
Injury Waiver: I acknowledge that participation in art activities carries some risk of minor injury (e.g., cuts, allergic reactions). I release Studio49 and its staff from liability in the event of accidental injury, except in cases of gross negligence.
Photo/Video Consent: By signing this form, I acknowledge and comply with the use of any photo or video content taken inside Studio49 specifically for the use of marketing and media materials. If I want to opt out, I will let the Studio49 Staff know.
Studio49 Policies and Procedures:
I have read through and agree to the following policies as seen in Studio49 Handbook (available on website and physical copy on site)
Assumption of Risk for Participation in Studio49 Activities
Parent/Guardian Notice: Studio49 Participation
Studio49 Rules of Conduct
Signature
By signing below, I acknowledge that I have read, understood, and agree to the terms of this consent form for Studio49.
Parent/Guardian Signature: ___________________________
Printed Name: ___________________________
Date: ___________________________