Registration Form

Participant Registration:

This form is required before participating in special events, workshops, classes, or any other activity associated with Dandelion Creative Space.
Participant's Full Name*

First NameLast Name
Age:
Years
D.O.B.*
Please type D.O.B in Month/Day/Year

Family Members / Multiple Particpants

If you are registering more than one particpant, please enter other registrants' information here. Skip this step if you are the sole registrant or if there is only one particpant is being registered. All particpants in a family unit should be included in registration form.
Participant 2 Name:

First NameLast Name
Age
Years
Date of Birth
Please type D.O.B in Month/Day/Year
Participant 3 Name:

First NameLast Name
Age
Years
Date of Birth
Please type D.O.B in Month/Day/Year
Participant 4 Name:

First NameLast Name
Age
Years
Date of Birth
Please type D.O.B in Month/Day/Year
Participant 5 Name:

First NameLast Name
Age
Years
Date of Birth
Please type D.O.B in Month/Day/Year
Participant 6 Name:

First NameLast Name
Age
Years
Date of Birth
Please type D.O.B in Month/Day/Year
Parent/Guardian Full Name (If over 18 please list N/A in both fields)*

First NameLast Name
Email*
example@example.com
Contact Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from physical address above):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Art Intrests

WatercolorMixed MediaArtistian Craft (Woodworking, jewelry making, etc.)AcrylicDrawingSculpturePotteryOther
How did you hear about us?*
Other

Medical Needs/ Allergies / Accommodations (Please put "N/A" if it does not apply):*
Letting us know of your or your child's medical needs and allergies prior to your visit will ensure that we can properly care and keep each participant safe.

Emergency Contact (Please list at least two adults who will be available at time of participation of services):*

	Full Name	Address	Contact Number
1
2

Assumption of Liability

In recognition of the potential hazards, I, or my children, my heirs and assigned, do hereby release Dandelion Creative Space, its owners and their family members, employees, their family members, program participants, their agents and anyone else acting in any capacity on their behalf from any and all liability, actions, causes of action, debts, claims and demands of every kind and nature whatsoever, and specifically including any claim for negligence or negligent acts, arising from my or my minor child’s participation in the Dandelion Creative Space. Student or Guardian/Parent hereby agrees to release, waive, covenant not to sue, indemnify and hold harmless dandelion creative space, its owners/directors, teachers, employees, or the owners of the location 120 Pacific Ave, Chehalis WA from any and all liability, claims, demands, judgments, actions, executions and causes of action whatsoever. I UNDERSTAND THAT I AM WAIVING MY RIGHT TO TAKE LEGAL ACTION INCLUDING FILING A LAWSUIT FOR PERSONAL INJURIES TO MY CHILD(REN) AND/OR MYSELF. This waiver and release is valid for all classes, events and programs provided by Dandelion Creative Space and it's partners.
Signature

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Contract

1) If signed up for the Family or Individual Club membership, or are particpating in a monthly clas, tuition is due by the 7th of each month prior to participation. A late fee of $10 will apply on all tuitions paid after that date.

2.) The studio will be closed on nationally recognized holidays
(Memorial Day, July 4th, Labor Day, Thanksgiving, Christmas Eve & Day, New Years Day)

3.) If your student misses a class during the month, he/she can come for a makeup class anytime during that month. Please contact studio to book a makeup class. One-time classes, workshops, and events do not apply.

4.) A minimum of one month written notice is required before withdrawing from any class. This enables us to keep spots available for students in waitlist.

5.) Dandelion Creative Space holds the right to cancel participant/family memberships at anytime and under their discretion to ensure that all employees, partipants/ patrons and general public are safe.

6.) All safety protocols and procedures will be followed to ensure that the studio is a safe and welcoming place for all.

Photographic Release

Promotional photos of particpants and their artwork helps our business grow! Please let us know your comfortablility regarding photos taken at Dandelion Creative Space while you or your child is attending.

I hereby authorize that photographs may be taken of the above registered participant and that such photographs may be published, including on the Dandelion Creative Space website on the internet and used to promote Dandelion Creative Space I also give permission to reproduce photographs taken of my/my minor child’s artwork for promotional purposes.
Signature

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Should be Empty:

Participant Registration: