Collaborative Models Workshop Information

Form
SESSION

Name:_______________________________
Address:______________________________
Email:________________________________

_____________________________________

Waiver Information:

Please provide information regarding participant's medical history, including all

drug and food allergies, pre-existing illnesses, physical, behavioural, emotional concerns. If there is nothing to
report/document, please write n/a:

___________________________________________________________________________________________________________________________
_________________________________________________________

Medical Treatment Authorization:

I give permission to CPAMO to arrange any emergency medical care including hospitalization/transportation, if
necessary. All participants are responsible for their own medical coverage. I hereby release CPAMO from all
liability and claims arising in relation to any matter including personal injury or damage to/loss of property,
regarding participation in any activity or otherwise and hereby indemnify CPAMO from and against such
claims.

Photo Permission and Release Form:

I give CPAMO permission to photograph, videotape, film and/or interview and to publish said photographs,
videotapes, films and/or interviews in CPAMO publications/printed material, including marketing and
promotional materials, and on CPAMO official website and any other social media, including but not limited to
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and demands with respect to any such use except as agreed to in writing.

Please check below:

I have provided the correct information above, read / understands all of CPAMO waiver
information and agree to adhere to all mentioned above.

SIGNATURE: ____________________________________
DATE: __________________________________________

Organization__________________________________
Phone:_______________________________________
Please check where applicable

CPAMO MEMBER

NON CPAMO MEMBER

Collaborative Models Workshop Information

Form
1) What are you or your organizations interest in a collaborative model?

2) Have you or your organization done collaborative work in the past

3) What are you hoping to achieve in these sessions?

4) What does the organization/artist think it can bring to a collaborative project?

5) Is your work postal code the same as your home?

If no please provide your work postal code
Work
________________

Home
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