Permission Form

Print off the form below and mail it plus fees (check or money order) to: 

Crockett Tavern Living History

Summer Workshops

C/O Sally A Baker CTM Site Director

Crockett Tavern Museum

2002 Morningside Drive, Morristown, TN 37814

   __ May 23, 2014 9-2:30 (Paper-Making, Candle-Making, Fire-Pit Cooking, Pioneer Chores)

   __ June 13, 2014 9-2:30 (Soap-Making,  Quill Writing, 18th Century Medicine, Old Wives Tales, Foodways)

   __ Both Workshops

Information:

Parent Name: ___________________  

Contact #: _________________

Address: _____________________________________________________________

_____________________________________________________________________

Child(ren) [names, ages and grade level]:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Email: ____________________

Emergency Contact (name and number other than number given): _____________________________________________________________________

Fees:

 Preregistered by May 14: $10 per student; Family Maximum $30

 After May 14: $14 per student; No Family Max

Permissions and Code:

By signing this form, I give permission for my family to participate in the Crockett Tavern Museum Living History Workshops and:

1. My Family and I will actively and fully participate together in the activities and class (lecture, discussion, hands-on) giving respect to speakers, other participants and the Museum and its collections.
2. Parents are responsible for monitoring, caring, and correcting their children during the programs.  This is an interactive family experience --  not a drop-off program.  Crockett Tavern speakers and other leaders are not responsible for child(ren) other than to cooperate to teach and encourage.
3. I grant Crockett Tavern Museum Living History Workshops and Crockett Tavern Museum permission to photograph, film, audio/video tape, record and/or televise my and the above listed child(ren)'s image and voice and biographical material in whole or in part in any medium known or developed in the future without any restrictions.
4. I will not hold Crockett Tavern Museum, Crockett Tavern Museum Living History Workshops and any other leaders or members of this cooperative liable for any accidents or injury to myself or the above listed child(ren).
5. I understand the opportunities for participation, fees and expectations. 
6. I willingly cooperate and participate in the Crockett Tavern Museum Living History Summer Workshop(s).  I will explain these expectations to my child(ren) expecting them to be aware and comply.

Signature: ______________________________________

Date: ___________________________________________

Fees paid: _____________  Payment Form: ___________

Please also send your name and the number, ages and grades of students you will have in attendance to luvbnma@hotmail.com  Thanks!