Creative Writer Form
Welcome to Muse Squad!
Student Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Parent or Guardian Information
First Name
Last Name
Email
example@example.com
Phone Number
How did you hear about Muse Squad?
Internet Search
Flyer
News or Publication
Social Media
Community Event
Recommended by Friend or Colleague
Digital or Print Brochure
Other
What do you hope for your child to gain from this creative writing experience?
To stay up to date on news, articles and events, would you like to subscribe to 'A Time To Write Bulletin'?
Yes, keep me in the loop! (You can unsubscribe at any time :)
No, not at this time.
I'm already subscribed.
I grant the non-profit organization, Muse Squad, permission to take photos and/or record on video, my child’s name, voice and image for informational programs, reports, publications and promotional purposes.
Yes, I allow my child to be photographed and/or recorded to document classes, workshops and events.
No, not at this time.
Comment or Question (Optional)
Signature
Submit
Submit
Should be Empty: