ArtReach art class
This is a monthly art class, taught by artist Eileen Driscoll for “X-tra special” differently-abled young adults (16+ years old) who enjoy making art. We will be doing a variety of projects and all materials will be provided. At this time, the class is limited to high-functioning young adults who can follow instructions, treat the art supplies appropriately, are verbal (at least to some degree), will stay in the classroom and treat others with respect.
Student's Name
First Name
Last Name
Student's age and birthdate
Allergies or medical conditions we need to be aware of?
Medications we should know about?
Please note: We are not medical professionals and cannot administer any medications. Students must self-administer, or a parent/guardian must remain on-site and available for both routine and emergency needs.
I understand and agree
Sensory, behavioral or learning considerations?
Photo release - is it ok to take pictures of the student in the class for social media?
yes
no
Responsible adult's name
First Name
Last Name
Responsible adult's email
example@example.com
Responsible adult's phone number
Please enter a valid phone number.
Texting ok to the above number (class updates)?
YES
NO
Other emergency contact - name and phone #
I understand the current focus of this class: to serve high-functioning differently-abled young adults. The student you are registering must be able to follow instructions, treat the art supplies appropriately, is verbal (at least to some degree), will stay in the classroom and treat others with respect.
YES, my student meets these criteria
My student does not meet the criteria to participate in this class. Please keep my information for future classes.
If discipline or behavior issues arise, at MWCA’s discretion, we may request that a parent or other responsible adult attend class and assist with the student’s instruction. Concentration and attention to instruction is needed; disruption cannot be an on-going concern. When necessary, MWCA reserves the right to refund any unused class fees and suspend the student from further participation. I understand and agree:
YES
Until we get to know your student better, we request that a responsible adult remain in our building during the class-time for at least the first time your student attends ArtReach. I understand and agree:
YES
Please share the student's interests and/or kinds of art he/she might enjoy.
Any additional information we need to know to help the student have an enjoyable and fulfilling experience?
Type a question
Signature
Waiver and Hold Harmless Agreement --- By enrolling in classes, workshops, camps, or events at Monroe-Walton Center for the Arts (MWCA), I acknowledge and accept all risks associated with participation. I agree to release, indemnify, and hold harmless MWCA, its staff, instructors, volunteers, and board members from any and all liability, claims, demands, and causes of action arising out of or related to any loss, damage, or injury, including illness, that may occur while participating in MWCA activities.I understand that MWCA is not responsible for providing medical care, and in the case of an emergency, I authorize MWCA staff or volunteers to seek emergency medical treatment on behalf of the participant, if necessary.*
*
I understand and agree
Photo Release: I give MWCA permission to use photographs or video taken during activities for promotional use (such as in social media, newsletters, or the website), without compensation. No names will be published without additional consent.
*
yes
no
Submit
Should be Empty: