Art Club Registration Form
Parent/Guardian Information
*
Indicates required field
Name Parent/Legal Guardian
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
Cell phone
*
Work phone
*
Young Artist(s) Information
Name
*
First
Last
Name
*
First
Last
Name
*
First
Last
Age
*
6
7
8
9
10
11
12
13
14
15
16
Age
*
6
7
8
9
10
11
12
13
14
15
16
Age
*
6
7
8
9
10
11
12
13
14
15
16
Emergency Contact(s) / Pick-up Permissions
Name
*
First
Last
Name
*
First
Last
Name
*
First
Last
Phone Number
*
Phone Number
*
Phone Number
*
Permission to pick-up child
*
Yes
No
Permission to pick-up child
*
Yes
No
Permission to pick-up child
*
Yes
No
Medical Information
Doctor
*
Doctor Phone Number
*
Preferred Hospital
*
Pardee
Mission
Park Ridge
Closest
Please list known allergies or sensitivities for each child you are registering. If no known allergies, type 'none'.
*
Any medical issues we should be aware of? If no, type 'none'.
*
Emergency Medical Care
In the event that my child is involved in
a serious incident while at CANVAS ArtSpace, I expect
to be contacted immediately at the above contact number.
In the event that my child requires immediate medical treatment
before I can be reached,
I
hereby authorize CANVAS ArtSpace
to
seek
emergency treatment on my behalf.
I understand that this authorization will remain valid
unless I contact CANVAS ArtSpace in writing
to withdraw it.
By checking the box below I certify I have read and agree to the above statement.
*
Authorization for emergency medical care.
Policies
Click here
to read our Class Payment Policy, including important information about cancellations, refunds and exchanges.
I have read and agree to the CANVAS ArtSpace payment policy.
*
Yes
Submit Form
