ARTx3 Class Registration Packet

ARTx3 Class Registration Packet

Please complete this packet before attending classes at the ARTx3 Campus.
First and Last Name*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Today's Date*

MonthDayYear
Date
Date Difference
Medical or other information we should know about you (i.e., heart problems): *
Additional Student Information

If the student is under 18 years of age, please complete the information below.
Parent or Guardian First and Last Name

First NameLast Name
Parent or Guardian Email
example@example.com
Parent or Guardian Phone Number
Please enter a valid phone number.
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Educational Programming Rules & Regulations
The Arts & Science Center’s Education Department provides unique learning experiences for individuals of all ages. If minimum enrollment is not reached, class may be canceled and payment will be refunded.
ELIGIBILITY
All are welcome to attend our education programs, however, strict age restrictions are in place to maintain the integrity of the programming. To register, complete the form and return it with payment to the Arts & Science Center before the registration deadline for each class. Class sizes are limited.
FEES
Payment is due at registration. An individual is not considered “enrolled” in a program until payment is received.
GUIDELINES & RELEASE
I agree to accept and abide by the rules and regulations of the program as established by the Arts & Science Center and to obey the direction of the Center’s representatives. I understand that video production and/or photography may be conducted during the program and my photo may be used for any Center purposes or sites. I understand the Center provides neither medical nor health insurance coverage for participants of any programs. I assume the risk of any and all damage, injury, death or harm which may occur to me or my property. I forever release and discharge the Arts & Science Center and its officers, directors, employees, agents, insurers from any and all claims and liability.

*Upon enrolling in a class it is understood that the program participant is aware of all rules and regulations previously stated.
By submitting this registration, the registrant agrees to abide by the mask protocol set forth by The Arts & Science Center for Southeast Arkansas (ASC), and assumes all risks, hazards, and dangers incidental to the event or workshop for which they have registered. registrant voluntarily waives any and all claims and potential claims against ASC, The ARTSpace on Main, ART WORKS on Main, event or workshop staff, event or workshop participants, and each of their respective employees, affiliates, officers, and directors, (collectively, for purposes of this policy, the “released entities”), that arise from or relate in any way to, however caused, the risk of contracting or the actual or alleged contracting of COVID-19 or any other communicable disease or illness, or that arise from or relate in any way to, however caused, the risk of exposure or actual or alleged exposure to a bacteria, virus or other pathogen capable of causing COVID-19 or any other communicable disease or illness, in each case whether the actual or alleged circumstances giving rise to any claim or potential claim occur before, during, or after the event or workshop. each registrant and others are subject to the release & waiver of liability agreement. Registrant assumes all risks and losses occurring before, during, or after an event or workshop, including, without limitation, illness or injury by any cause, and releases each released entity (as defined above) from any and all related claims.
Agreement*

I have read and understand the rules and regulations.
Should be Empty:

ARTx3 Class Registration Packet

Additional Student Information

Emergency Contact Information

Educational Programming Rules & Regulations

ELIGIBILITY

FEES

GUIDELINES & RELEASE