Teen Studio 2021 Registration Form

Teen Studio Registration 2021

UVA’s popular Teen Studio program returns with monthly themed courses that meet once a week on Wednesdays after school (2:30-4:30pm) for four weeks. March Teen Studio will meet March 3, 10, 17, and 24; April Teen Studio will meet April 7, 14, 21, and 28; and May Teen Studio will meet 5, 12, 19, and 26. Teen Studio is open for young artists aged 13 and up.
Contact Information
Student Name *

First Name Last Name
Student Age *
Age
Parent or Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number *

Area Code Phone Number
Mobile Phone (Optional)

Area Code Phone Number
E-mail *

Confirmation Email
Are you a UVAA Member? *

Yes No
Secondary Emergency Contact

In case of emergency, we will contact you at the phone number provided above. Other than yourself, is there someone else you would like us to contact in case of an emergency? If so, please provide their contact information below.
Full Name

First Name Last Name
Phone Number

Area Code Phone Number
Relation to Student
Relation
Optional Medical Information

Please share any of the student's allergies or medical conditions that UVA might need to know about in case of an emergency.
Allergies
Medical Conditions
COVID-19 Policies
Umpqua Valley Arts is committed to operating our art classes in a safe and responsible manner and will continue to adopt and adhere to the Department of Education and Oregon State Department guidelines as released. Our classes will be led in a positive, engaging manner to help kids create and connect within these special times and learn to use art as an instrument for expression and change. We know that young artists will have an incredible time creating with us!
- Students will be in cohorts of no more than 8
- Students and staff will practice social distancing of at least 6 feet
- UVA will provide enhanced health screening methods for staff and students at check-in
- UVA cleans and disinfects all shared spaces between use, and students and staff will wash and/or sanitize hands early and often
- UVA is considered an indoor public space. All staff and volunteers will be required to wear masks (cloth face coverings)
- Cloth face coverings (masks) are required for students in accordance with Oregon state mandates on mask-wearing
Please check that you have read the above policies *

I have read the Teen Studio policies on safety.
Medical Release
Please Check Below: *

I (we) authorize Umpqua Valley Arts Association and their representatives, to authorize medical attention by certified medical personnel (i.e. EMT, First Responder, E. R. Physician) for my son/daughter, which may become necessary. I (we) understand that I (we) will be notified as soon as possible in the event of an emergency. My insurance company or I will assume all expenses of such treatment. I (we) agree to protect, defend, indemnify and hold harmless Umpqua Valley Arts Association, including its board of directors, employees, artists and volunteers from and against all claims, demand, losses, suits, liabilities, costs or other damages including court costs and attorney fees.
Photo Release
Please Check One Below: *

I give permission for pictures taken of my child and/or my child's artwork to be used for publicity purposes. I do not give permission.
Refund Policy
Please check that you have read the following: *

Full payment at time of registration is required. Should you need to cancel a student's registration in the Teen Studio, no refunds will be issued, but if you cancel at least one week in advance we will gladly credit the student for registration in a future week or month of the Studio (depending on their current registration). Full refunds will be made in the event that UVA has to cancel the Studio before the month begins. In the event that UVA has to cancel the Studio partway through the month due to pandemic-related events, pro-rated partial refunds will be issued for the unused portion of the month.
Registration and Billing Information
March Teen Studio will meet March 3, 10, 17, and 24; April Teen Studio will meet April 7, 14, 21, and 28; and May Teen Studio will meet 5, 12, 19, and 26. Teen Studio meets Wednesdays 2:30-4:30pm.

Please select one or more of the following. Each class is $35.00 for the entire month (4 sessions).
February Teen Studio
March Teen Studio
April Teen Studio
May Teen Studio
Confirm your selected class(es). Please make sure you have also selected the same class(es) in the selections above! *

March: 3, 10, 17, 24 April: 7, 14, 21, 28 May: 5, 12, 19, 26
Total
Payment Total

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USD Description
You will be taken to a secure PayPal gateway to complete your submission.

Please Note: You do not need a PayPal account to complete the purchase, simply enter as "guest" then continue to enter your payment information.
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Teen Studio Registration 2021

Contact Information

Secondary Emergency Contact

Optional Medical Information

COVID-19 Policies

Medical Release

Photo Release

Refund Policy

Registration and Billing Information