Name
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First Name
Last Name
Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
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Age Range
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Under 18
19-24
25-64
65 and older
Ethnicity
Asian
Black/African American
Native American/Alaska
Hispanic/LatinX
White/Caucasian
Other
Prefer not to disclose
Course for which you are applying:
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Start date of course/workshop
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MM
DD
YYYY
Emergency contact name
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Emergency contact phone
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(###)
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Outline your personal goals for your craft:
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What part of your total income are you attempting to make or do you expect to make from your craft (not required if under 18)?
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What is your household’s adjusted gross income level on your most recent federal tax return?
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How many family members are supported by this income?
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GIVING BACK TO THE ACS:
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Every year, our scholarship fund is renewed during our Gala Fundraising event, held in November. As part of your scholarship agreement, we ask that students donate artwork that is valued at the same amount, or more than your scholarship award. This can be one large piece, or several smaller pieces. If student is unable to donate artwork to help us renew our scholarship fund, they may volunteer a number of hours (@ $20.00 per hour to equal value of scholarship award) to assist with the various tasks that help in our organization’s day-to-day functioning. Please indicate below which option you would prefer:
Waiver of Liability Relating to Coronavirus/COVID-19
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The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life threatening illness and even death.
Arkansas Craft School cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing Arkansas Craft School’s services or premises. It is not possible to prevent the presence of the disease. Therefore, if you choose to utilize Arkansas Craft School’s services and/or enter onto Arkansas Craft School’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.
ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Arkansas Craft School’s services and enter Arkansas Craft School’s premises. These services are of such value to me [and/or to my children] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Arkansas Craft School’s services and premises in person.
WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Arkansas Craft School and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Arkansas Craft School’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.
CHOICE OF LAW: I understand and agree that the laws of the State of Arkansas will apply to this contract.
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE:
Date of Signing Waiver of Liability Relating to Coronavirus/COVID-19
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Type today's date.
MM
DD
YYYY
Date of Parent/Legal Guardian Signing Waiver of Liability Relating to Coronavirus/COVID-19
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Enter today's date.
MM
DD
YYYY
Date of signing Vaccination Agreement
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Enter today's date.
MM
DD
YYYY
Date of Signing Mask Compliance
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Enter today's date.
MM
DD
YYYY
Type your name to sign this form:
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Leave a note or comment to ACS.
