Teen Art Experience Registration
Participant Name
*
First Name
Last Name
Participant pronouns
Emergency Contact Information
Parent / Guardian Name
*
First Name
Last Name
Parent / Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent / Guardian Email
*
example@example.com
Parent / Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Contact
First Name
Last Name
Secondary Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Photo Release
ArtStart has my permission to use my photograph of my child publically to promote the program. I understand the images may be used in print, website, and/or social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
*
ArtStart has my permission to share images of my child
ArtStart does not have my permission to share images of my child
Submit
Should be Empty: