Creative Kids Class

Parent Completing This Form*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Student Name 1*

First NameLast Name

Age of Student 1*

Where is Student 1 Attending School?*

Do you have more than 1 child who will be attending?*

YESNO

Student Name 2

First NameLast Name

Age of Student 2

Where is Student 2 Attending School

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Alternate Phone Number

Please enter a valid phone number.

Emergency Contact 1*

Name and Phone Number

Emergency Contact 2

Name and Phone Number

Authorized To Pick Up - Please list individuals and contact phone numbers who you authorize to pick up your child. NOTE: It is the parents responsibility to notify the Studio if any changes are to be made to the list below. IF NONE OTHER THAN THE PARENT COMPLETING THIS FORM, ENTER "NONE":

Please note any medical or other concerns/conditions/handicaps/medications/food or other allergies, of which we should be made aware. IF NONE, INDICATE "NONE" BELOW:*

Please enter any additional comments below:

How did you hear about us?

I understand that CREATIVE KIDS CLASS is held Sunday 4 to 6pm at our DRAGONFLY LOFT location - 1611 Colley Ave, Norfolk - just one block from our main studio:*

I understand

I understand that STAIRS ARE REQUIRED - The Dragonfly Loft is located on the second floor.*

I understand

GENERAL POLICIES

By participating in classes at The Dragonfly, you agree to the following:

Payment: Payments are recurring on the day of the month you originally registered, and will continue automatically until cancelled. You may cancel by giving us 14 days notice.

Liability Waiver: The Dragonfly Art Studio will do all within its ability to promote a safe, nurturing, stimulating, and fun environment for students. The Studio and associated personnel, including teachers, staff, etc., are not liable for any injury, accident, or damage to any person or property. Your signature below releases The Dragonfly Art Studio from any claims that may arise from participation in, or attendance of, classes, events or activities. By signing this form, you agree that you have read the full Liability Waiver at the following link: CLICK HERE TO VIEW.|

Photo Release: The Dragonfly Art Studio may periodically photograph students, personnel and facilities during classes or activities. These photographs are used in a variety of ways, including public relations and marketing purposes on brochures, posters, and newsletters, on associated websites, and/or other art, education, or news related publications and other media. Your signature indicates your approval to use images and photos as outlined above.

Security: Our facilitiy is closed to the public during class time and only those attending class or associated directly with the Studio are allowed to be present. To ensure further security and quality of service, all public areas of our premises are covered by security cameras that record 24/7.

Minor Students, Expectations, Behavior, etc.: Students are expected to be courteous, polite, kind, focused, and positive during lessons. Conversation is allowed between students with the understanding that discourse will be polite and respectful, and that students will remain quiet and attentive when the instructor is speaking or at any other time as directed. At his or her sole discretion, teacher may take appropriate action when behavior is deemed unacceptable or inappropriate, to include disallowing additional conversation, separating students, and/or ending lessons early for an individual student or an entire class. In the event that the instructor decides to end classes, parent or parents will be immediately called, and students shall be picked up as soon as possible. In the event that class is ended early due to behavioral issues, no refund will be given. If the teacher determines that the student may not return, no credit or refund will be given for any prepaid classes.

General Studio Policies: Our general studio policies are viewable at the following link: CLICK HERE TO VIEW

Signature*