Van Gogh and Friends After-School Art Classes

Student Registration Form

Ten Weeks: November 4-January 30 Tuesday Classes: Advanced Fine Art: 2:40-4:15 Grades 1-5 Wednesday Class: Art Exploration: 1:15-2:30 Grades TK-K
Student Name

First NameLast Name
Birthdate

MonthDayYear
Date
Address

Street Address

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Parent Mobile Number
Optional Second ParentPhone Number
Emergency Number
Allergies
By completing and signing this form, I hereby agree to the following:
1. I am voluntarily authorizing the participation of above named minor in After-School Art classes taught by Marcia Williams and held at Lakeside Joint School District

2. I assume full responsibility for any risks, injuries, or damages that may happen as a result of my child’s participation in this After School Art Classes.

3. Additionally, I WAIVE AND RELEASE, indemnify, hold harmless and forever
discharge Marcia Williams and Lakeside Joint School District and their employees and agents employees, officers, trustees, affiliates, successors, and assignsfrom any claim for such injuries, damages, or death resulting from my
child’s participation in this event/activity.
Signature

Clear

My Products

Tuesday After School Art Class: Grades 1-510 Weeks: November 4 - January 30

$380.00 Quantity

Wednesday After School Art Class: Grades TK-210 Weeks: November 4-January 30

$380.00 Quantity

Total

$0.00

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Student Registration Form