RDS ArtReach Program – Parent/Guardian Registration
This form is for a parent or guardian to register their child for the RDS ArtReach program. Please complete all relevant sections below.
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child Full Name
*
First Name
Last Name
Child Age
*
Child Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
School Name
*
Child’s Art Interests or Preferred Activities
*
Allergies or Medical Information Relevant to Participation
*
Accessibility or Accommodation Needs
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about the RDS ArtReach Program?
*
Please Select
School
Friend/Family
Social Media
Community Event
Flyer/Poster
Other
Additional Notes or Comments
Waiver and Release
By signing below, I acknowledge that participation in art program activities involves normal risks. I accept responsibility for those risks and agree to release and hold harmless RDS, the ArtReach program, and their staff, volunteers, and partners from claims arising from my child’s participation, except where prohibited by law. I also agree to follow program rules and understand that failure to do so may affect participation.
I have read and agree to the Waiver and Release above.
*
Photo and Media Release
RDS/ArtReach may use photographs, video, and artwork created by my child during the program for educational, promotional, website, social media, and print materials. I understand this use is without compensation.
Photo and Media Release Permission
*
Grant permission
Decline permission
Submit Registration
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