Holidays Art Club Sign Up

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Art Club Six week session with Suzanne Stewart
$150 per student

How many children are you signing up? *

Name of children enrolling *

Age & Grade *

Parent's Name (both if Applicable) *

Phone #

Email Address

Emergency Contact Name and Relation to Child *

Emergency Contact Phone Number *

Who is your child exiting with? Pick ups at front door unless they are going to pass *

Name any additional approved pick up people if needed. Also include phone number.

I understand my child is not registered unless this form is completed and a payment is completed. *

Yes

Required

Liability Disclaimer & Notices: please read carefully I individually and as parent and/or guardian of the minor child identified above hereby acknowledge the following notices and grant to Art Club, Suzanne Stewart Art, the following release from liability: A. I acknowledge and fully understand that I, or my child, will be engaging in use of art supplies and tools, art room, active games, and including possibly some physical activities that may involve some risk of injury. I acknowledge and have been advised that it is my responsibility to consult with my or my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my or my child’s participation. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by my child which might incur as a result or participating in this program and discharge and hold harmless Art Club, Suzanne Stewart Art, its owners, directors, members, employees and agents from any claim, cause of action or liability for damages arising from any personal injury to my child or other persons or property caused by myself or my child’s participation in the Art Club. B. I clearly understand that refunds will not be granted for this class. C. I agree to give Art Club permission to use photographs of myself or my child for any Art Club, Suzanne Stewart Art promotional materials. I understand that my child will not be identified by name, nor will any compensation be extended for such use. risk of injury. I acknowledge and have been advised that it is my responsibility to consult with my or my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my or my child’s participation. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by my child which might incur as a result or participating in this program and discharge and hold harmless Art Club, Suzanne Stewart Art, its owners, directors, members, employees and agents from any claim, cause of action or liability for damages arising from any personal injury to my child or other persons or property caused by myself or my child’s participation in the Art Club. *

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