Art Club Registration & Consent Form

Participant Name(s)

First NameLast Name

Name participant(s) goes by

Participant Age(s)/Grade(s)

Participant Pronouns

Caregiver Name (if participant is under 18)

First NameLast Name

Caregiver Pronouns

Phone Number

Please list the best number to receive workshop communication..Format: (000) 000-0000.

Email Address

Please list the best email address to receive workshop communication and information..

Anything that would be helpful for us to know? (e.g. accommodations, how you or your child learns best, what helps you or your child feel comfortable)

Any allergies? (please specify)

I understand that this program is educational/creative in nature and is not intended to replace individual therapy or other professional mental health care. Participation is voluntary and may involve ordinary risks associated with program activities (including the use of materials and tools that might be hot or sharp). I voluntarily assume these risks and agree to release the program facilitator and organization from liability for ordinary negligence to the extent permitted by law. This waiver does not release liability that cannot legally be waived.

In the event of an emergency, I authorize the program facilitator or designated staff to contact emergency services and, if necessary, seek emergency medical care on my behalf. I understand that emergency services may be contacted regardless of this choice when reasonably necessary to address an immediate emergency.

Preferred Hospital:

Emergency Contact:

Please list name and relationship

Emergency Contact Phone Number:

Intentionally Small Groups: We limit spots so everyone has plenty of space to create, connect, and enjoy the experience.

ESA+ Famiies: Please use the designated discount code at check out.

Refund Policy: Because supplies and planning are tied to your registration, fees are non-refundable unless we cancel the program.

Can't Make It? Pass It On: While we cannot issue refunds, you are welcome to transfer your registration to a friend up to 72 hours before the event.

How to Transfer: Please email contact@littlehouseartstherapy.com with your friend's full name and email address so we can reach out to them directly to share a check out code for the transfer, collect their info and welcome them.

Honoring Our Team: This policy helps us honor the time, materials purchased, and detailed preparation required for our programming.

Thank you for helping us keep Little House programs welcoming, sustainable, and full of creative connection!

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Workshops/Groups:

Art Club: Middle and High School

Collage Shadow Boxes

Sunday, October 11th, 2-4 pm

All materials included, no art experience necessary!

This workshop needs a minimum of 5 participants. If minimum attendance isn't met 1 week prior to the workshop, the event will be canceled and all registrants will be refunded in full.

$40.00 Quantity

Art Club: Kid Edition (K-5th Grade)

School's Out, Art's In!

Friday, October 23rd, 1-2:30pm

All materials included, no art experience necessary!

This workshop needs a minimum of 5 participants. If minimum attendance isn't met 1 week prior to the workshop, the event will be canceled and all registrants will be refunded in full.

$40.00 Quantity

Enter coupon

Subtotal

Tax

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Signature

Art Club Registration & Consent Form

Art Club Participant Waiver & Emergency Information

Photos

Our Registration & Refund Policy:

Workshops/Groups:

Art Club Registration & Consent Form

Art Club Participant Waiver & Emergency Information

Photos

Our Registration & Refund Policy:

Workshops/Groups:*

Workshops/Groups: