RDS ArtReach Program – Adult Registration
Register for the RDS ArtReach Program as an adult participant. Please complete all required fields and review the waiver and media release sections.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Organization or Affiliation (optional)
What are your art interests?
*
Painting
Drawing
Sculpture
Photography
Mixed Media
Other
Allergies or Medical Information
*
Accessibility Needs
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about the program?
*
Please Select
Friend or Family
Social Media
Website
Community Organization
Event or Flyer
Other
Additional Notes (optional)
Waiver and Release Agreement
Photo/Media Release
Do you grant permission for RDS/ArtReach to use your photo or likeness in program materials and media?
*
Yes, I grant permission
No, I do not grant permission
Register
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