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The Ludington Area Center for the Arts After-School Art-Ventures Consent Form
Please fill out a consent form for each student participating in the program.
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CONTACT INFORMATION
Student(s) Name
Please list all the students you have enrolled.
Your answer
Student(s) Grade
If you have more than one student enrolled, please indicate grade for each.
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian
Phone Number
This is the first number we will call. Please provide the best number to reach you during our program.
Your answer
Parent/Guardian
A
dditional number
This is the second number we will call.
Your answer
Parent/Guardian
Email
Your answer
Emergency Contact Name
This is the third number we will call.
Your answer
Emergency Contact Phone Number
Your answer
Student’s School (for future programing purposes)
Your answer
ALLERGIES and ACCOMMODATIONS
If you have more than one student enrolled, please indicate who has allergies or requires accommodations.
Food Allergies
Your answer
Accommodations
Your answer
TRANSPORTATION to LACA
We understand plans could change. Please keep LACA (
programs@ludingtonartscenter.org
)
updated.
How will your student arrive to LACA?
My student(s) will use LADS School Bus transportation from Ludington Elementary to LACA
Student(s) will be dropped off.
Student(s) will use Dial-A-Ride.
Other:
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