registration

The following general information about your child will help Foundation for New American Art provide a safe and comfortable experience for your child. Please send this form and a photo of your child to info@foundationfornewamericanart.org Make sure you update this form if the information changes.

Child's Name

Date of Birth

Date

Home Phone

Address and Phone No. of Caregiver if different than above

Child will be dropped off at 3:30 pm and picked up by 5 pm

School child attends

Weight

Height

Grade

Favorite Subject/Hobby.

Name

Caregiver/Guardian Name

Employer or School

Phone

Address

Days and hours of employment

Other Caregiver or Guardian Name

Title/Position

Employer or School

Phone

Address

Days and hours of employment

Where else parents or guardians may be reached

In case of an emergency (i.e., child becomes ill, needs transportation home) and the parent cannot be reached, please list two other people who may be called for assistance. Select people who live in the area and have transportation. Make sure you discuss these responsibilities with them. NamePhone

Name

Phone

Persons authorized to pick up the child (other than parents):

Name

Phone

Name

Phone

Names and ages of any siblings

Other family/household information

Model Release Consent : Do you mind if we photograph or film your child to use in special reports for our funders? (circle one) YES/NO

Child's Doctor

Phone

Please list any allergies or chronic illnesses your child may have and include the symptoms and any special care needed

Please list foods that your child particularly likes or

Please list foods that your child particularly likes or dislikes

Please give any special information about your child that might be helpful