Event Registration Is this a gift? Yes No Valid for Open Studio Passes only.Gift Purchaser Information:Purchaser Name:* First Last Purchaser Email:* Purchaser Contact Phone Number:*Parent Information:Parent's Name:* First Last Parent's Email:* Parent's Phone Number:*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 2nd Parent's Name: First Last 3rd Parent's Name: First Last Event Information:How did you hear about us?Events:*Private Pop-up Play - Mondays - 2:00 - 4:00Seasonal Pop-up PlayPrivate Pop-up has a minimum of 4 families Event Date:* MM slash DD slash YYYY Please check CPCC Calendar for available dates and times!Time : Hours Minutes AM PM AM/PM Please check the CPCC Calendar for available dates and times! Open Studio Pass Information Open Studio passes are honored for 1 year from the date of purchase. Total Number of Children Attending:*Please enter a number from 1 to 5.Count of all your children in attendance Number of Children Attending:Total number of children attending eventCoupon Code: Total: $0.00 Children's InformationChild's Name:* First Last Child's Age:*2nd Child's Name:* First Last 2nd Child's Age:*3rd Child's Name:* First Last 3rd Child's Age:*4th Child's Name:* First Last 4th Child's Age:*5th Child's Name:* First Last 5th Child's Age:*Caregiver InformationCaregiver: A caregiver will be responsible for my children Name of Caregiver:* First Last Photo ReleasePhoto Release Permission: I/We give permission for photos/videos to be taken of: Child's Name: First Last 2nd Child's Name: First Last 3rd Child's Name: First Last 4th Child's Name: First Last 5th Child's Name: First Last while he/she is participating in Meridian Learning activities. I/We understand that photos/video may be published online, in printed materials and/or for other promotional purposes, but only to help document student work and illustrate Meridian Learning programs. I/We hereby waive any ownership rights, as well as any right that I/we may have to inspect or approve the finished product in which a photographic or video image may be used including the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.WaiverIn exchange for Meridian Learning allowing my child (“Child(ren)”) to participate in activities (“Activities”) I agree to the following: Voluntary Participation. I understand and confirm that I am voluntarily allowing my Child(ren) to participate in the Activities. Identification of Risks. I understand my Child(ren)’s participation in the Activities may involve risk of injury and loss, both to person and property. I also understand the risk of injury to my Child(ren) may include the possibility of permanent disability and death. I understand this Waiver and Release is intended to address all risks arising out of or relating to my Child(ren)’s participation in the Activities, including risks created by actions, inactions, or negligence on the part of Meridian Learning or its members, managers, officers, employees, agents, volunteers, successors, or assigns (collectively, the “Representatives”), and that these risks, may include, but are not limited to, risks created by the following: The use and condition of Meridian Learning’s premises, facilities, and equipment; The lack or inadequacy of policies, rules, regulations, or supervision for the Activities; The failure of Meridian Learning or its Representatives to foresee or to protect me or my Child(ren) from actions, inactions, or negligence of any person, or the recklessness, intentional, or criminal misconduct of persons other than those affiliated with Meridian Learning; and The inadequacy or unavailability of medical facilities or treatment. Assumption of Risk. On behalf of my Child(ren) and myself, I assume all risks, known and unknown, foreseeable and unforeseeable, in any way connected with my Child(ren)’s participation in the Activities, and I accept personal responsibility for any liability, injury, loss, or damage in any way connected with my Child(ren)’s participation in the Activities. Release and Waiver. On behalf of my Child(ren) and myself, I release Meridian Learning, LLC and its Representatives from any and all liability, and waive any and all claims, for liability, injury, loss, damage, or expense, including attorneys’ fees, in any way connected with my Child(ren)’s participation in the Activities, whether or not caused in whole or in part by the negligence or other misconduct of Meridian Learning or its Representatives (a “Claim”). Indemnification. I agree to indemnify and to hold harmless Meridian Learning and its Representatives from any Claim or expense, including attorneys’ fees (including the cost of defending any Claim I might make, or that might be made on my behalf, that is released or waived hereby), in any way connected with a Claim. Binding Effect. This instrument shall be binding upon my Child(ren), relatives, next of kin, personal representatives, heirs, beneficiaries, and assigns, and me, and inure to the benefit of Meridian Learning and its Representatives. Medical Treatment. I authorize Meridian Learning and its Representatives to provide my Child(ren), through medical personnel of their choice, customary medical assistance, transportation, and emergency medical services should my Child(ren) require such assistance, transportation, or services due to injury or damage related to the Activities. This does not impose upon Meridian Learning or its Representatives to provide such assistance, transportation, or services. Severability. If any provision of this Waiver and Release is held to be invalid or unenforceable, such invalidity or unenforceability shall not otherwise affect any other provision of this instrument. Applicable Law. This instrument shall be governed in accordance with the law of the State of Ohio. Studio Rules Adults are responsible for all children who accompany them at all times. No shoes or strollers are allowed in studio. All food and beverage must be kept in waiting area. Children must be prepared to respectfully participate in group activities. Please treat the learning space, materials and staff with respect. The infant area is designed for children who are not yet walking. The toddler area is for children under 2.5 years of age. Thank you for your participation in our community of friends!Agreement:Children's Information, Caregiver Information, Photo Release & Waiver Acknowledgement:* By signing below, you are agreeing that the Children's Information & Caregiver Information provided is accurate and that you read the Photo Release and Waiver. Additionally, only in the case of event cancellation by CPCC will fees be refunded. My signature below indicates that I agree to all of the above provisions regarding my family’s and caregiver's participation in the program. Gift Notification* The gift recipient will complete a signed copy of this form upon first use of the Open Studio Pass Parent/Guardian:* First Last Parent/Guardian Signature:*Additional Parent/Guardian: First Last Additional Parent/Guardian Signature: