Art Mobile - Parent/Guardian Consent Form
This form is for the parents/guardians of minors signing up for an Art Mobile class hosted by Jeffersonville Public Art. Parents/guardians of minors must review and agree to the terms below.   We appreciate your understanding and cooperation in ensuring the safety of our young participants. 
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date of the event *
Name of Minor Participant *
Name of Parent/Guardian *
NOTE: THIS RESERVATION WILL NOT BE CONFIRMED until the parent/guardian of minor reviews & agrees to all terms below.

> Unaccompanied minors can be dropped off for the duration of the class.
> Pickup and drop-off times should not extend 30 minutes past class start/end times
> Two VALID emergency contact numbers must be provided.
> All minors are expected to follow class guidelines and instructions 

By agreeing to these terms, you (the parent or guardian) understand that Jeffersonville Public Art and its affiliates cannot assume liability for the actions or behavior of minors under our supervision before, during, or after the designated class time.
Do you understand and agree to the terms above regarding your responsibility for this minor? *
Providing accurate contact information assists us in swiftly addressing any unforeseen situations. 
Emergency Contact #1
First / Last Name *
Emergency Contact #1
Phone Number
(xxx)-xxx-xxxx *
Emergency Contact #2
First / Last Name *
Emergency Contact #2
Phone Number
(xxx)-xxx-xxxx *
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