Mosaic Art Class

Mosaic Art Class Registration Form

Waiver of Liability

I agree to release, indemnify and save harmless the Town of Pilot Butte, and its elected officials, officers, employees, agents, representatives, volunteers, and other participants from and against all claims, proceedings and/or actions in respect of any costs, losses, damage or injury arising by reason of my or the dependent registrants’ participation in any activities offered by the Town of Pilot Butte, or by reason of the provision of medical care by the Town to me or the dependent registrants.

Town of Pilot Butte Image Release

I hereby grant permission for my child to be photographed during the program for memorabilia and/or promotional material. I further acknowledge that the Town of Pilot Butte are the owners of all publication materials, and that photos may be used in any exhibitions, public displays, publications, commercial art, and advertising purposes including television without limit or reservation.