REGISTER YOUR STUDENT

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

*Filling out this form does not guarantee enrollment... we will send you a confirmation via email. Some may end up on the waitlist. Waitlist students get priority for following sessions.

Students Name: *

Students Grade/Teacher:
*

PARENT/GUARDIAN NAME: *

Parent/Gaurdian Phone #: *

e-mail: *

WHO IS AUTHORIZED TO PICK UP YOUR STUDENT: *

IS YOUR STUDENT WALKING HOME BY THEMSELVES? *

WILL YOUR STUDENT GO TO YMCA/CAMPFIRE AFTERWARDS? *

Yes

Maybe

Emergency Contact Number: *

Any health concerns or matters we should know about?

By entering my name below, I, the parent or legal guardian of the above named participant, understand the possibility of any and all injury resulting from the activities of this art class. I hearby acknowledge and accept risks incidental to participation in such activities. I hearby release, absolve, indemnify and hold harmless Michelle Smit and Cool Art School. I hearby consent to emergency medical treatment based on the information provided by me.
*

I, the parent or legal guardian, give consent to Michelle Smit and Cool Art School to use a photograph of the participant and their artwork for publicity purposes.
*

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms