Student Registration

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

Thank you for registering for our event. The following information is important for us to have in order to give your child/children the best experience possible. Please enter the information to the best of your abilities. If you have questions, feel free to reach us at 203-245-2689 or email: madisonartsbarn@gmail.com

Participant's First Name *

Participant's Last Name *

Gender (preference/pronoun) *

Date of Birth *

YYYY

Grade *

Which artform(s) do you have interest and ability in, and would like to be considered for when a business needs help?
*

Filmmaking

Photography

Social Media Content

Graphic Design (Flyers, Logos, Websites)

Other:

Required

The Barn is committed to fulfilling the needs of the community and having an inclusive and welcoming environment for its participants and their families. To ensure we are respecting and advancing our diversity, we need to gather certain information below. Please check ALL the boxes that apply to you if you feel comfortable to do so. *

Indigenous American or Alaskan Native

Asian

African American/Black

Hispanic or Latino/a/x

Native Hawaiian / Pacific Islander

White

Choose Not to Answer

Other:

Required

Does your child have any Allergies? *

Yes

If yes, please give us more information, ie. what is the allergy and what actions would be needed, if any.

Does the participant have any medical, emotional, or social concerns that we should be aware of? *

If No, please enter "none" If Yes, please explain.

Street Address *

Town of Residence *

Parent's Email: *

These emails will be added to our constant contact list to notify you of events and updates, as well as important information about this event/program. If you prefer to not be added, please let us know at madisonartsbarn@gmail.com. PLEASE DO NOT ENTER A SCHOOL EMAIL. If you would like more than one email address on the notification list please list all of them here

1st Parent's/Guardian's Name: *

1st Parent's/Guardians' Cell Phone Number *

2nd Parent's/Guardian's Name: *

2nd Parent/Guardian's Cell Phone Number *

Emergency Contact: Name *

Emergency Contact: Cell Number *

Would you like to register another participant from the same household that will be attending this event/program? *

Yes (you will be sent to a section to fill out their information) )

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