2025 Participant Form

Wonderland Creative Center

To be submitted sometime before your student or intern’s participation in the Wonderland Creative Center’s Summer 2025 program.

If you’d like to confirm that we have received your information or if you have any questions about the form below reach out to cassandra@wonderlandcreativecenter.com.

Dates Attending Program

Select all that apply

Week 1 // July 7-11

Week 2 // July 14-18

Week 3 // August 4-8

Week 4 // August 11-15

Participant #1 Name

Participant #2 Name

(if applicable)

Participant #3 Name

(if applicable)

Parent/Guardian #1 Name

Parent/Guardian #1 Email

Parent/Guardian #1 Phone Number

(###)

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Parent/Guardian #2 Name

Parent/Guardian #2 Email

Parent/Guardian #2 Phone Number

(###)

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Emergency Contact Name

To be contacted in the case of an emergency.

Emergency Contact Phone Number

(###)

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Transportation Instructions

Regarding drop off, pick up, walk home, and/or biking. If persons other than parent are dropping off/picking up, provide their name & phone number here.

Allergies, medications, dietary restrictions and/or health history

List any allergies, medications, dietary restrictions and/or health history relevant to this outdoor art program.

Learning, behavior and/or physical restrictions

List any learning, behavior and/or physical restrictions relevant to this outdoor art program.

Preferred medical facility and family physician's contact information

For emergency use only.

Additional Information

Let us know if there is anything else you think we should know!

Medical Authorization and Parent Liability Release

I, the undersigned adult, on behalf of myself and child(ren) assume all risks and hazards related to the program. Further, I do hereby release and hold harmless Cassandra Monson, parent helpers, or interns connected with the program from any and all claims, injuries, damages and suits arising out of or in connection with the program. I acknowledge that I have familiarized myself with the description of activities, understanding the hazards and my child(ren)’s personal limitations, and knowingly assume all risks. In the event of a medical emergency, I authorize transportation to the nearest medical facility (Fairview Riverside or Abbott Northwestern) and authorize emergency medical care if no one listed can be reached. My child(ren) has permission to engage in all prescribed program activities except as noted. The information provided on this form is accurate. I have indicated any special health conditions, restrictions or limitations which should be known. My child(ren)’s behavior will not include violence or bullying. My child(ren) will be sensitive to other people’s ideas and values. My child(ren) will be respectful of the environment, “leave no trace”, follow hiking safety standards and stay within eyesight of Cassandra at all times. If inappropriate behavior continues after conversations the participant could be asked to leave. Cassandra Monson’s Summer Art Program is a safe and caring environment where individual differences are valued and we safely interact with the natural world.

By checking this box you agree to the terms above

Photo Release

I hereby give permission to Cassandra Monson and the Wonderland Creative Center to take photos of my child making art with their friends. These photos will be shared with all camp families and used to advertise the program on the internet.

I DO NOT give permission to Cassandra Monson and the Wonderland Creative Center to take photos of my child.