Enrollment Form for ONLINE PROGRAMS

Online LIVE STREAMING Programs & Workshops

Please complete and submit this form with payment. We will send an email with instructions for the Live Classes.
Parent/Legal Guardian*

First NameLast Name
E-mail*
How did you hear about us?*
Phone Number

Area CodePhone Number
Emergency Contact

First NameLast Name
Emergency Contact Phone #

Area CodePhone Number
Number of Children
How many Kids are you Registering?
Child's name (1)*

First NameLast Name
Childs Birth Date (1)*

MonthDayYear
Child's name (2)

First NameLast Name
Childs Birth Date (2)

MonthDayYear
Child's name (3)

First NameLast Name
Childs Birth Date (3)

MonthDayYear
A bit more info and you will be done! Click next and select your Class.

LIVE STREAMING PROGRAMS*

Registration Fee (1 per family)$15.00

Registration Fee is due at registration once a year per family, renewed each year.

Ages 5-7 yr. - LIVE STREAMING Mixed Media Art Classes$55.00

A creative and educational class, weekly for one hour, live streaming on Zoom for ages 5-7 yr..

Select Payment ScheduleQuantitySelect your class schedule
Item subtotal:$0.00

Ages 6-10 yr. - LIVE STREAMING Mixed Media Homeschool Art Classes $60.00

A creative and educational class, weekly for one hours, live streaming for ages 6-10 yr.

Select Payment ScheduleQuantitySelect your class scheduleSelect your class schedule
Item subtotal:$0.00

Ages 8-12 yr. - LIVE STREAMING Mixed Media Art Classes $65.00

A creative and educational class, weekly for 75 minutes, live streaming for ages 5-7 yr..

Select Payment ScheduleQuantitySelect your class schedule
Item subtotal:$0.00

Creative Sketch Journal Workshop - weekly classes LIVE STREAMING$50.00

A creative and relaxing workshop for adults - weekly for 75 minutes, live streaming

Select Payment ScheduleQuantitySelect your class schedule
Item subtotal:$0.00

Enter coupon

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

You are almost done! Hang in there and click next!

ASSUMPTION OF RISK, RELEASE, WAIVER AND INDEMNIFICATION
I hereby acknowledge, agree, and accept the risk of injury inherent in any physical activity or program, including particularly, the activities offered by Little Blank Canvas. Such risks may include but are not limited to falling, bumping, risks from abrasions, scrapes, cuts, broken, sprained or bruised limbs, injury to eyes, consumption or inhalation of paint or other media, as well as risks from the actions or omissions of others.
As such, I hereby release, discharge, indemnify and hold harmless Little Blank Canvas, its owners, members, managers, instructors, affiliates, agents, employees, successors and assigns, from any and all injuries, illnesses, medical conditions, medical care, death, damages, claims, liabilities, expenses or judgments, including attorneys’ fees and court costs resulting from my, my child(ren)'s, or my child(ren)'s caregiver’s participation in a program or presence on Little Blank Canvas premises or other location where Little Blank Canvas may conduct art instruction, except as such may arise out of Little Blank Canvas's gross negligence.
I expressly agree that Little Blank Canvas may use photos, video, sound recordings taken of me and my child(ren), for any purpose, including use for publicity. In addition, I agree that Little Blank Canvas shall have a fully-paid, perpetual license to use photographs, copies or reproductions of any work of art produced in its studio by me or my child(ren).
I hereby release Little Blank Canvas from any damage or loss to any of my personal property.
I understand and agree to all of the terms of this Permission Form and all questions that I may have had related to this Form have been answered to my satisfaction, and I understand that this constitutes a waiver and release of liability of Little Blank Canvas. I acknowledge receipt of and agree to the Little Blank Canvas policies.
Signature*
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Online LIVE STREAMING Programs & Workshops