Spring & Summer Registration

Register for Spring & Summer Ink!
Thank you for your interest in Lake Erie Ink's creative expression programs for youth!

If we cancel a class session due to low enrollment, you will receive a full refund. However, we cannot refund money for a session that you are not able to attend. We do not offer refunds if a program is ended early due to COVID 19. We can give you credit for another program. Partial scholarships are available for all programs.

You will receive program details a week prior to the session via email. If you have any questions, please email staff@lakeerieink.org or call 216-320-4757. Thank you!
Parent/Guardian Email Address*
example@example.com
Child Name*

First NameLast Name

Parent/Guardian and Emergency Contact Information
First Parent/Guardian Full Name*

First NameLast Name
First Parent/Guardian Relationship to Student*
First Parent/Guardian Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
First Parent/Guardian Email*
example@example.com
Second Parent/Guardian Full Name

First NameLast Name
Second Parent/Guardian Relationship to Student
Second Parent/Guardian Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Parent/Guardian Email
example@example.com
Alternate Emergency Contact (optional):

First NameLast Name
Alternate Emergency Contact Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Relationship to Student:

Medical/Emergency Information
Please describe any special learning concerns you might have for your child:
Please describe any medical or health concerns (i.e. allergies, asthma, diabetes, etc.):
YesNo
Pickup Information
YesNo
Please list the names and numbers of anyone who has permission to pick up your child (other than the parents/guardians listed above):
Liability Release: I understand and agree that Lake Erie Ink: A Writing Space for Youth (hereafter “LEI”) is not responsible for supervising my child or for my child’s safety after the end of the program, and that neither LEI nor any of its staff members is liable for any physical or emotional harm to my child, caused by my child’s negligence or by the negligence, intentional act or criminal act of a third party, nor for any property or damage or loss caused by my child.*

I understand and agree with the above.

Permissions
YesNo
YesNo
Field Trip Permission

During programs, we may want to take your child outside on a walking field trip or to a local site for writing inspiration. Parents and guardians will be notified in advance of any off-site travel.
I grant permission for my child to go on field trips with staff and volunteers of Lake Erie Ink. I understand that the Lake Erie Ink: a writing space for youth staff and volunteers will exercise every reasonable caution in supervising the field trip. My child understands that they must follow all of the safety rules established by the staff and volunteers, and that failure to follow rules that could place them or others in danger will mean that my child may not be permitted to attend future field trips. I release Lake Erie Ink: a writing space for youth from all liability in case of accident or injury. (If the following boxes are not checked, you may be responsible for transporting your child to any field trip locations.)

On footOn public transportation (bus or rapid transit)
Please sign below to verify the information provided on this form is accurate.*

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Register for Spring & Summer Ink!

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