SBMA Enrollment Student Information

Santa Barbara Museum of Art

Emerging Teens Program Application and Waiver Form
Spring Session: Textiles + Printmaking
April 11 – March 16, 2024
Thursdays 4 – 6pm

These sessions will take place at the Ridley Tree Education Center at 1600 Santa Barbara Street.

*April 18 session will take place at Museum
1. Applicant Information

Please enter student information below.
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Phone Number

Area CodePhone Number
Email
example@example.com
Grade (Winter 2024)
School
Can you commit to all the dates/times listed for the session you are applying to?

YesNo
If not, please explain:
2. Parent/Guardian Information

Please enter parent/guardian information below.
Parent/Guardian 1 Full Name*

First NameLast Name
Parent/Guardian 1 Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Parent/Guardian 1 E-mail*
Parent/Guardian 1 Home Phone*
Parent/Guardian 1 Work Phone*
Parent/Guardian 1 Mobile Phone*
Parent/ Guardian 2 Full Name (optional)

First NameLast Name
Parent/ Guardian 2 Address (optional)

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Parent/ Guardian 2 E-mail (optional)
example@example.com
Parent/ Guardian 2 Home Phone (optional)
Parent/ Guardian 2 Work Phone (optional)
Parent/ Guardian 2 Mobile Phone (optional)
3. Additional Student Authorized Pickup

Please enter names and telephone numbers in the box below of any additional people that may pickup student from this workshop (grandparents, brothers/sisters, after-care providers, etc.).
These individuals are authorized to pickup student
Please include name and telephone number.
4. Emergency/Medical Information

Please enter the following emergency/medical information below.
Alternate emergency contact to call if guardians cannot be reached - local resident*

First NameLast Name
Alternate emergency contact phone - local resident*

Area CodePhone Number
Alternate emergency contact relationship to student*
Student Special Needs
Student Allergies
Medications Taken by Student
5. Medical Release Waiver

PARENTAL CONSENT: TO BE SIGNED BY PARENTS OR GUARDIANS WHO HAVE PARTICIPANTSUNDER THE AGE OF 18
I hereby give the Santa Barbara Museum of Art my permission to obtain qualified medical attention for my child in case of an emergency with the understanding that I will be contacted as soon as possible. I understand that my child may be using art supplies and tools that may cause minor harm if not used properly as instructed.
I agree to the Medical Release Waiver. Please sign below with your mouse or finger if on a touch device.

Clear
Print Name: First Name* Last Name* , Date: Date*

Relationship to student: *
6. Photo Release Waiver

Use of Photography
Occasionally the Santa Barbara Museum of Art uses photography of young people taken at the Santa Barbara Museum of Art, the Ridley-Tree Education Center at McCormick House, or on Museum-directed field trips to chronicle youth and family activities related to the Museum. These images may be published in Museum newsletters, class schedules, informational brochures, on the Museum’s web site, or in other Museum advertising and publications. It is also possible that the images may be submitted to the news media for publication.

By your signature below you are consenting to the above-mentioned use of your child’s photograph.
I agree to the Photo Release Waiver. Please sign below with your mouse or finger if on a touch device.

Clear
Print Name: First Name Last Name , Date: Date
7. COVID-19 Terms and Release Waiver

Currently, masks are not required. This is subject to change based on the guidelines set by the Santa Barbara Unified School District. In the event that these guidelines do change, please read and agree to the following:
I agree to my child wearing a face mask at all times while on site at the Santa Barbara Museum of Art and maintaining a distance of 6 feet from other students and SBMA staff not in their household. My child will not attend E-Teens if I/we are sick, have any symptoms of COVID-19, have had symptoms or been in contact with anyone displaying symptoms in the last 14 days. My family is not under a mandated quarantine or self-isolation period order by the public health department. I understand despite stringent cleaning and sanitizing protocols, SBMA cannot control all circumstances. By participating in E-Teens, I acknowledge that I assume any risks associated with my child’s participation, including but not limited to a risk of injury or illness. These terms are subject to change as county or state regulations are updated.
I agree to the COVID-19 Terms and Release Waiver. Please sign below with your mouse or finger if on a touch device.

Clear
Print Name: First Name Last Name , Date: Date
Should be Empty:

Santa Barbara Museum of Art

1. Applicant Information

2. Parent/Guardian Information

3. Additional Student Authorized Pickup

4. Emergency/Medical Information

5. Medical Release Waiver

6. Photo Release Waiver

7. COVID-19 Terms and Release Waiver