Home 9 Youth Programming Participant Conduct Agreement Youth Programs Student Conduct Agreement Please enable JavaScript in your browser to complete this form.Lyme Academy youth programming strives to provide each member with the most enjoyable experience possible. There is zero tolerance for inappropriate behavior, and this includes, but is not limited to, offensive language or statements, physical abuse, bullying and/or stealing. Such behaviors warrant immediate dismissal from the Lyme Academy Youth Programs. Parents/guardians will be notified should any issues with their child arise. By indicating acceptance below and signing forms at the start of the program, you indicate that you have read and agree with the Lyme Academy of Fine Arts Conduct Agreement.FOR THE STUDENT:I have read and understand the Student Conduct Policy and have checked the box below to indicate that I agree to accept the consequences of my actions.I understand and accept.Student Name *FirstLastDateStudent Signature (leave blank – to be signed at the start of the program.)FOR THE PARENT/GUARDIAN:I have read and understand the Participant Conduct Policy and have checked the box below to indicate that I agree to pick up my participant if his/her behavior warrants this end result.I understand and accept.Parent/Guardian Name *FirstLastDate Parent/Guardian Signature (leave blank – to be signed at the start of the program.)PUBLICITY/MEDIA DISCLOSURE FOR THE PARENT/GUARDIAN:Throughout the course, your child may be photographed and/or included in a video taken for newspaper. television, in-house use on the Academy's website, or for other publicity purposes. Please check below to indicate that you DO or DO NOT grant permission to use your child's picture. (If no choice is made, it will be assumed that you do not want your child's picture used.)Publicity/Media PermissionI DO grant permission to use my child's picture.I DO NOT grant permission to use my child's picture.Parent/Guardian Signature (Leave Blank – to be signed at the start of the program.)HOLD HARMLESS AGREEMENT DISCLOSURE FOR THE PARENT/GUARDIAN:I have read the policies and information sheet and hereby give my child permission to participate in all program activities. I also understand current medical information must be on file prior to the start of the program session, IName *FirstLast, agree to insure, defend and hold the Lyme Academy of Fine Arts, its officers, employees, and agents harmless from any and all costs, losses, expenses, damages, claims, suits, or any liability whatsoever, including attorney's fees, resulting from injury, including death, to person or damage to property arising out of, or in any manner connected with, the Lyme Academy of Fine Arts. Please check the box below to indicate your agreement.Hold Harmless Agreement CertificationI agree to the Hold Harmless Agreement conditions noted above.Parent/Guardian Signature (leave blank – to be signed at the start of the program.)DateSubmit
