GT Prep

Student First Name*
Student Last Name*
Home Street Address*
City*
State*
Zip*
Parent's Name*
Parent's E-mail*
Phone Number*
Emergency Contact Name*
Emergency Cell Phone*
Student is in Grade*
Student Birthday

MonthDayYear
Date
Release of Liability: I hereby agree to be responsible for the conduct and actions of my child and release STEAM Works Studio and employees from any claims and demands that may occur during participation in classes which may arise from incidents/accidents involving my child, held on the premises of STEAM Works Studio, to the extent allowed by law.
Signature*
Date*

MonthDayYear
Date
Permission for Release of Content for STEAM Works Studio publications, website, and social media including Facebook and Twitter, for participants in classes, camps, and activities. I hereby consent that my child’s image, and likeness, as shown in videos, photographs, film, and/or electronics images and/or audio recordings of my child’s voice many be used by STEAM Works Studio for purposes of event documentation, media coverage, and promotion, and are the sole property of STEAM Works Studio.
Signature
Date

MonthDayYear
Date
Please Call to Confirm!!

STEAM Works Studio - Frisco/Mckinney

603-727-8169
www.steamworksstudio.com/frisco
frisco@steamworksstudio.com
Should be Empty: