Plasterminds Winter Break Drop In Registration Form

Dear Parent/Guardian,

We are excited to welcome your child to the Plasterminds Drop in days! Before we embark on this creative journey together, we want to ensure that you have all the necessary information regarding our program. Please read this form thoroughly and acknowledge your consent by signing at the bottom.

Child Name*

First NameLast Name

Birth Date

MonthDayYear

Grade

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

12/21/24 (12 pm - 3 pm) $4012/30/24 (10 am - 1 pm) $40

Parent/Guardian Information

Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the child prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

During Winter Break Drop-In Days at Plasterminds, students in grades 2 and up can enjoy a variety of hands-on activities designed to spark creativity and fun. They'll explore arts and crafts projects, including paint-your-own pottery and other imaginative creations. In addition to crafting, participants can relax with pizza, snacks, and family-friendly movies, creating a well-rounded and engaging day. It's a perfect mix of artistic expression, socializing, and downtime for kids during the holiday season.

Safety Measures:

• We prioritize the safety and well-being of all our camp participants.
• Our studio is equipped with appropriate safety measures to ensure a secure environment.
• All art materials used during the camp are non-toxic and safe for children.

Supervision:

• Qualified instructors will supervise the children at all times during the camp.

Health and Medical Information:

• Please inform us of any medical conditions, allergies, or special needs that your child may have. This information will help us provide appropriate care and accommodations.
• In case of a medical emergency, we will make every effort to contact you or the emergency contact provided.

Plasterminds Studio is not a nut-free zone. While we take measures to minimize the risk of exposure to allergens, we cannot guarantee a nut-free environment.

Photography and Media Consent:

• We may take photographs or videos during the camp for promotional purposes, including our website, social media, and marketing materials.
• By signing this form, you consent to the use of your child’s likeness in such promotional materials.

Parent/Guardian Responsibilities:

Please ensure that your child arrives on time and is picked up promptly at the end of each camp session.
Inform us of any changes to contact information or emergency contacts.
Placing a $50 deposit is to secure your child's spot. Please note that cancellations made within 7 days of the start date are non-refundable.

Acknowledgment:
I, {name}, acknowledge that I have read and understand the information provided in this Informed Consent and Acknowledgment Form. I consent to my child, {childName}, participating in the Plasterminds Kids Art Summer Camp. I understand and agree to the terms outlined above.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

Drop In Registration

Artist Information