Mindful Mending Student Name * First Name Last Name Email * Phone * (###) ### #### Are you registering as an Individual or a Family ? * Individual Family (2 or more workshop participants) Release of Liability * I hereby authorize my child to participate in the workshop taught by Center for the Arts Eagle Rock (CFAER). I agree to hold the City of Los Angeles, Eagle Rock Community Cultural Association dba Center for the Arts Eagle Rock, and all its directors, officers, agents, and employees, free and harmless from any liability, injuries, and damages that may arise from my child's participation in workshop activities. My electronic signature below indicates that I have read this entire form and agree to the terms. I affirm that I have authority to sign this consent and release of liability. Covid-19 Vaccination Status * This workshop series is for vaccinated individuals ages 12+ only; thank you for your understanding. We are asking that each workshop participant provide proof of vaccination status before attending. To emphasize safety for everyone we are doing the following: - Workshop sessions will take place outside on the lawn at the Women's Twentieth Century Club, but please still bring a mask with you as they are required for venturing inside the club. - At each session we will take individual health screenings and temperature checks before the start of the workshop. Are you fully vaccinated against Covid-19? Yes No Thank you! Please complete payment in your cart at top of page.
