The Youth Arts Series Art Lab
Tuesdays and Thursdays
3:30 PM–5:00 PM
Ages 10–17

Thursday, 4/14
Tuesday, 4/19
Friday, 4/22
Thursday, 4/28
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Email *
Before registering, please review the following information regarding Covid-19 safety measures:
-Face masks must be worn while indoors.
-If you or your child have, or have been in contact with anyone who has, cold/flu-like symptoms, or are feeling unwell in any way, PLEASE STAY HOME.
Student's First Name *
Student's Last Name *
Student's  Age *
Student's School *
First Name of Parent/Legal Guardian *
Last Name of Parent/Legal Guardian *
Relationship to Student *
Street Address (for our records only - we will not share this information or use it for advertising purposes) *
City *
Zip Code *
Email Address *
Phone Number (xxx) xxx-xxxx *
Name of Emergency Contact (if different from person listed above) *
Relationship to student *
Emergency Contact's Phone Number (xxx) xxx-xxxx *
Please list any existing medical conditions or disability that may limit, restrict, or impair their activities (i.e. severe asthma, diabetes, seizure disorder, etc.). *
Please list any allergies (i.e. food, environmental, bee stings, etc.). *
If yes, how is he/she treated? *
I grant permission for the student listed to attend the East Hawai‘i Cultural Center’s Youth Arts Series Program, and hereby release all directors, coordinators, staff members and instructors of any claim for damages, liability, injury, expense, or loss on account of any negligence or other wrongdoing that may occur while my child is attending the program. I also agree to indemnify and hold harmless those persons of the above stated organization on any claim arising out of the Youth Arts Series activities under this agreement. *
In case of an accident or need for medical attention, I give permission to the Youth Arts Series staff, coordinators, or instructors to take my child to a doctor, and/or emergency medical facility. It is understood that the cost for treatment will be borne by the parent or guardian. *
 I give permission to the Youth Arts Series to film, tape, or otherwise record our child’s name, voice, and/or person. I understand that these recordings of my child may include news releases which include photographs about the East Hawai‘i Cultural Center and other media releases to publicize the Youth Arts Series programs and classes and open circuit (broadcast), closed-circuit, and/or cable television transmission within or outside of the State of Hawai‘i in perpetuity. I also understand that there will be no financial or other remuneration for recording of my child, either for initial or subsequent transmission or playback. The East Hawai‘i Cultural Center may also use my child’s name, likeness, and/or bibliographical identification for publicizing and promoting the use of these recordings. *
By checking this box I acknowledge that my child has received their COVID-19 vaccination at least 10 days prior to the first day of class. OR will take a COVID-19 within 72 hours prior to each lab day. *
A copy of your responses will be emailed to the address you provided.
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