Families/Individuals who do not have a signed form cannot participate in the program.
PARTICIPANT CONSENT FORM
We/I _________________ (adult’s full name) hereby certify that I am the parent or legal guardian of and
I apply for _________________ (child’s full name) to be admitted into the Sleepover program of the
Natural History Museum of Los Angeles County / the La Brea Tar Pits and Museum on __________
(date) from 6:30PM until 9:00AM. His/her date of birth is ______________ (child’s date of birth). I
understand that he/she will be working under the direction of Museum Staff and his/her group leaders at
the Museum. We/I agree that work done in this program will be subject to all rules of the Museum. We/I
hereby release the County of Los Angeles, the Los Angeles County Natural History Museum Foundation
and their respective officers, employees and agents from any claims, costs, losses, or injuries related to
the participation of __________________ (child’s full name) in the program.
I understand that photographs of program participants may be taken by the Museum. As a condition of the
family/child being admitted into the program, I agree that the Museum has the right to take photographs
of our family/child and use the photographs to benefit the Museum.
List full names and birth dates of all participants in the same family who are registered for the Sleepover.
If no other family members will be attending the event, please leave blank:
1. Name:
Date of Birth:
2. Name:
Date of Birth:
3. Name:
Date of Birth:
4. Name:
Date of Birth:
Signature of Parent or Guardian
Printed Name of Parent or Guardian
EMERGENCY CONTACT INFORMATION
Name of Emergency Contact
Emergency Contact Phone Number
Address of Emergency Contact
Natural History Museum900 Exposition Blvd. Los Angeles, CA 90007
Phone: 213-763-3221 Fax: 213-743-4831 Email: [email protected]
Terms & Conditions
In consideration of being allowed by the Natural History Museum of Los Angeles County (“Museum”) to
participate in the Sleepover (the “Program”), I hereby agree that:
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I understand that video production and/or photography may be conducted during the Program. I
grant full and irrevocable consent to the Natural History Museum of Los Angeles County and
those acting under its permission or upon its authority, the unqualified right and permission to
reproduce, copyright, publish, or otherwise use my photographic likeness.
I understand and expressly assume the risk of any and all damage, injury, death, or harm which
may occur to me or my property.
I understand that Museum staff is not responsible for any medical procedures or emergencies, and
is not responsible for administering medical assistance or aid to me or anyone in my group.
I agree to accept and abide by the rules and regulations of the Program as established by the
Museum and to obey the direction of the Museum’s representatives.
I understand that alcohol and drugs are not permitted.
I understand that outside food is only allowed in designated areas on Museum property.
I understand that the Museum reserves the right to discard anything that is left behind and is not
responsible for lost or stolen items.
I understand that male adult chaperones may be present during “Girls Only” sleepovers.
I forever release and discharge the Los Angeles County Museum of Natural History Foundation
and the County of Los Angeles its officers, directors, employees, agents, assigns, and insurers
from any and all claims or liability arising out of or in connection with my participation in the
Program. This release includes libel, invasion of privacy, negligence, or other fault that result in
personal injury, death, or property damage during or in connection with the above program or
activities. This release will be constructed according to the law of California State. This
Permission and Release shall inure to the benefit of licenses, agents, representatives and assigns
of the Museum, and shall be binding upon myself, my relatives, my heirs, estate, personal
representatives, and assigns.
Per Museum policy and for the safety of all of our guests, only Sleepover participants are allowed
into the Museum during the Sleepover program. Anyone who is not registered in the program will
not be permitted into the Museum, including parents who are dropping-off their kids.
Refunds for cancellations will not be given at any time. Should this Program be cancelled for any
reason by the Museum, a full refund will be given.
Signature
Printed Name
Natural History Museum900 Exposition Blvd. Los Angeles, CA 90007
Phone: 213-763-3221 Fax: 213-743-4831Email: [email protected]
Date