Art Club Registration Form

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- Child Portraits
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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 *

Emergency Contact(s) / Pick-up Permissions

Name *

First

Last

Name *

First

Last

Name *

First

Last

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

CANVAS ArtSpace
212 S. Church Street
Hendersonville, NC 28792
828-577-4590

Tuesday - Saturday, 10 am - 5 pm
Sunday by appointment

About
Gallery
Commissions
- Child Portraits
- Pet Portraits
Classes
EVENTS
- Calendar
Contact