Name *

First Name

Last Name

Session Date *

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DD

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Phone *

Please enter in US format (eg 000 000 0000)

(###)

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone

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If you require postage please fill out the address form below

Address 1

Address 2

City

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Release agreement for artists: *

I agree to the fullest extent to be responsible for any medical bills, which may incur resulting from illness or injury during my participation in art classes. I understand and agree that I am expected to carry accident and medical insurance. I release the instructor of the art classes from any and all liability ad / or claims and /or damages arising out of personal injury of any kind. If necessary, I authorize the art instructor of art classes to administer first aid and / or authorise medical treatment for me.

Photos: I authorise my arts / crafts to be displayed in the gallery, and that it and myself may be photographed for promotion purposes. (if you object, please let your instructor know prior to commencement)