Paint It Out - Registration & Consent Portal

Official Registration

Paint It Out

Consent, Enrollment & Emergency Medical Release Portal

Current Step 1 of 5

Child Info Media Release Program & Rules Medical Info Artwork & Sign

Student & Program Information

Please provide details regarding the participating student and their primary parent or legal guardian.

Student's Full Name *

Student's Date of Birth *

Parent / Guardian Full Name *

Program Name *

Instructor Name *

Parent's Phone Number *

Parent's Email Address *

Photo & Media Release

Permission to photograph, record, and preserve student activities.

I grant permission for my child to be photographed, videotaped, and/or recorded during participation in Paint It Out program activities.

I understand that these photographs, videos, and recordings may be used for:

Educational purposes
Classroom displays
Program documentation
Marketing & promotions
Social media platforms
Website content
Printed materials

• I understand that no compensation will be provided for the use of these images or recordings.

• I release and hold harmless the instructor, program, and affiliated organizations from any claims related to the use of such media.

Please select your preference: *

YES

I grant photo/video permission.

I do not grant permission.

Parent/Guardian Signature *

Sign inside the canvas below

Printed Legal Name

Date Signed

Program Participation Consent

Authorized rules, medical limitations, and therapeutic/enrichment disclaimers.

IMPORTANT DISCLAIMER & SCOPE OF SERVICE

Please note: Paint It Out programs are educational and enrichment-based and do not provide therapy, counseling, psychological treatment, or medical services.

I give permission for my child to participate in art and educational activities conducted by Paint It Out. I understand that activities may include:

Art projects

Painting, drawing, sculpting & multi-media work.

Group discussions

Peer sharing, reviews, and community building.

Social-emotional learning

Mindfulness, stress-relief and positive self-image.

Creative movement

Dynamic arts play, dance expression, and physical flow.

I acknowledge that reasonable precautions will be taken to provide a safe, nurturing, and structured environment for all participants.

Parent/Guardian Signature *

Sign inside the canvas below

Printed Legal Name

Date Signed

Emergency Contact & Medical Form

Vital security contacts and healthcare directions for rapid emergencies.

Primary Backup Emergency Contact

Backup Contact Name *

Relationship to Student *

Backup Phone *

Critical Medical Information

Allergies (Nuts, Penicillin, Dust, Latex, etc. Write 'None' if applicable)

Medical Concerns / Conditions (Asthma, ADHD, Heart history. Write 'None' if applicable)

Current Medications (Dosages, rescue inhalers, EpiPen locations. Write 'None' if applicable)

Artwork Release

Permission to safely show and feature your student's gorgeous canvas masterpieces.

I grant permission for my child's artwork to be displayed, reproduced, or shared for educational, promotional, or program-related purposes.

Under strict security and safety protocols, my child's first name only may be used in connection with any showcased artwork.

Please select your preference: *

YES

I grant artwork display permission.

I do not grant display permission.

Parent/Guardian Signature *

Sign inside the canvas below

Printed Legal Name

Date Signed

Review & Save Records

Once submitted, your agreement is saved, emailed directly to Paint It Out registry administrators, and formatted for printing.

Registration Completed

Document Saved & Recorded!

Thank you for registering your child with Paint It Out. The details have been safely logged. Please click "Compose & Send Email Log" to complete the email verification.

Instructor Authentication

Please enter the Paint It Out system administrator code to view student registries.

Admin Level Paint It Out Registry

Instructor Records Portal

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Student	Age / DOB	Parent / Contact	Allergies & Medical Alert	Permissions	Actions
Retrieving safe cloud records...

Paint It Out

Official Student Consent & Emergency Medical File

Original Electronic Copy

Date: [Date]

1. Student & Program Registry

Student Name: [Name]

Date of Birth: [DOB]

Parent/Guardian: [Parent]

Program Name: [Program]

Phone Number: [Phone]

Email Address: [Email]

Instructor: Paint It Out Staff

2. Photo & Video Consent Form

I grant permission for my child to be photographed, videotaped, and/or recorded during participation in program activities. I understand that these photographs, videos, and recordings may be used for educational purposes, classroom displays, program documentation, marketing/promotional materials, social media platforms, website content, and printed materials.

Consent Preference Select: [Yes/No]

Legal Digital Signature:

Signed By: [Name]

Date Signed: [Date]

3. Program Participation Release

IMPORTANT NOTICE: Paint It Out programs are educational and enrichment-based and do not provide therapy, counseling, psychological treatment, or medical services.

I give permission for my child to participate in art and educational activities conducted by Paint It Out. I understand that activities may include art projects, group discussions, social-emotional learning activities, creative movement, and educational games.

Legal Digital Signature:

Signed By: [Name]

Date Signed: [Date]

4. Emergency Contact & Medical Profile

Emergency Backup: [Name]

Relationship: [Rel]

Phone: [Phone]

Allergies: [Allergies]

Medical Concerns/Conditions: [Concerns]

Medications: [Meds]

5. Artwork Release Permission

I grant permission for my child's artwork to be displayed, reproduced, or shared for educational, promotional, or program-related purposes. My child's first name only may be used in connection with the artwork.

Consent Preference Select: [Yes/No]

Legal Digital Signature:

Signed By: [Name]

Date Signed: [Date]

Providing enriching arts instruction and positive creative learning modules.