Registration Form - Kids CREATE (2nd Sunday Art Club)

Registration + Permission Form

Participation in Kids CREATE - 2nd Sunday Art Club
STUDENT INFO:
County of Residence*
Student's Name:*

First NameLast Name
Does your child have a nickname they wish to use?
School Grade*
Age*
Student's Date of Birth*

MonthDayYear
Date
Registering for (select all that apply):*

* WAITLIST * 2nd Sundays Art Club: March 9 (ages 8-14)* WAITLIST * 2nd Sundays Art Club: April 13 (ages 8-14)* WAITLIST * 2nd Sundays Art Club: May 11 (ages 8-14)* WAITLIST * 2nd Sundays Art Club: June 8 (ages 8-14)
* For those on the waitlist *

Please fill out the form and we will be in touch to let you know if a spot opens up. Signing up not only saves you a spot but it also helps us understand the level of interest so that we can plan for future opportunities. Thank you!
How did you hear about this program?*

InstagramFacebookCREATE newsletterWord of MouthOther
GUARDIAN / PARENT INFO:
Guardian / Parent's Name:*

First NameLast Name
Email Address*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT INFO:
Emergency Contact:*

First NameLast Name
Relationship to Student:*
Phone Number*
Please enter a valid phone number.
PERMISSION
PERMISSION NOTICE 1: I understand that participation in this activity involves a certain degree of risk. I have carefully considered the risk involved and have given my consent for my child’s participation.*

YESNO
PERMISSION NOTICE 2: I also understand that CREATE will document classes for grant recording, archival, and promotional purposes, using photo, video, or audio recording and understand that this may include likenesses of my child.*

YESNO
PERMISSION NOTICE 3: I grant permission for CREATE to use photo, audio, or video recordings of my child in appropriate and safe social media platforms to document and share program activities in non-commercial use.*

YESNO
By signing this form, I declare that I am the legal parent/guardian of the Student (minor child) listed above and authorized to grant such permission. Please sign below.
Signature*

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Registration + Permission Form

STUDENT INFO:

GUARDIAN / PARENT INFO:

EMERGENCY CONTACT INFO:

PERMISSION