Fall 2019 Class Registration

Child's First Name *

Child's Last Name *

Age *

Birthday *

Parent/Guardian's First Name(s) *

Parent/Guardian's Last Name(s) *

Address *

Street Address
Street Address Line 2
City	State
Postal / Zip Code	Country

Work or Home Phone

Cell Phone *

Email *

Caregiver's Name (if bringing child to class)

Any additional information regarding your child that would be helpful for us to know.

How did you hear about Arts on the Horizon? (check all that apply)

Social Media Friend/Word of Mouth Parent Listserv/Group Online Parent Blog/Calendar Arts on the Horizon Newsletter or Email Internet Search My Child's Preschool

Stories Come to Life classes are held 10:00am - 10:45am

Stories on the Horizon classes are held 11:00am - 12:00pm

at
Convergence
1819 N. Quaker Ln.
Alexandria, VA 22302

PayPal *

Six-Week Stories on the Horizon: Bouncing Into Fall (Oct 12 - Nov 16, 2019) $ 60.00

Six-Week Stories Come to Life: The Wonderful World of Eric Carle (Oct 12 - Nov 16, 2019) $ 90.00

Total $ 0.00

By registering your child, you are agreeing to the following:

The information I have provided on this form is correct as far as I know
Arts on the Horizon reserves the right to use, for promotional or archival purposes, any photo or video taken in classes or camps.
Although every effort is made to provide a safe environment, I recognize there is always a risk of accident or injury. I agree to be responsible for any medical expense incurred from illness or injury as a result of my child's participation in Arts on the Horizon’s classes or camps. I understand that children are expected to be covered by their own, or their parent’s or guardian’s, insurance. Accordingly, I hereby release Arts on the Horizon from any and all liability, claims, or damages arising out of my child’s participation at Arts in the Horizon’s classes or camps. Additionally, I authorize Arts on the Horizon to administer necessary treatment for my child. I hereby further release Arts on the Horizon from any and all liability, claims, or damages that may result from such administration of treatment.
I have read, understood, and agree to the information listed above.

Electronic Signature *

Date *

You will receive an e-mail confirmation and additional information once your registration has been processed.

For questions, please contact:

Shea‐Mikal Green, Director of Education

education@artsonthehorizon.org

Fall 2019 Class Registration

Student's Information

Payment Information