C.A.N. On-Line Class Consent Form for December 2020

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Conservatory ASL Northwest utilizes the Zoom platform to host learning opportunities for youth and adults. These meetings will be secured with controlled waiting room entry and a meeting room password.
Parents are encouraged to participate with their children. We value your privacy and security and will use your contact info only for contacting you. You can also see Zoom's privacy and security information at https://zoom.us/privacy-and-security

Email *

I am at least 18 years of age. *

Yes

Required

Name of adult/parent/guardian: *

Phone Number: *

Name of child or children participating: *

Age(s) of child or children participating *

I give permission for myself and/or my child to participate in C.A.N.'s Zoom group meetings and to use this platform. *

Yes

Required

I understand that some meetings may be recorded for archival and social media purposes. Meetings may be posted in part or totality on the internet. I give consent for myself and/or my child to participate in these recorded meetings. *

Yes

Required

To respect the privacy of other participants I will not record or photograph the meeting or its attendees. *

Yes

Required

By typing my name, I give my consent for myself and/or my child to participate in C.A.N.'s on-line meetings. Futhermore, I hereby waive, release, covenant not to sue and forever discharge active and all other persons associated with Conservatory ASL Northwest, for all liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my registration and/or participation in this program, including without limitation any liabilities, claims, actions, or damages caused by negligence of the above parties (including any negligent rescue attempt), the action or inaction of any of the above parties, or otherwise : *

I am interested in the following chat sessions:

Meet with Patrick Graybill (11/30/20)

ASL School with Cecily for ages 4-7 (12/2,9,16/20)

ASL Success Chat with Shawn - Mechanic (12/3/20)

De'VIA Connect with Takiyah (12/4/20)

Meet with DJ Kurs (12/8/20)

ASL Success Chat with Shawn - Landscaper (12/10/20)

One Heart Call Connect Workshop (12/11/20)

De'VIA Connect with Cynthia (12/18/20)

Today's Date: *

YYYY

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