General Registration Form - Art With Heart Studio

GENERAL REGISTRATION FORM!

What program are you registering for? *

Participant's Name (First & Last) *

Participant's D.O.B. *

Allergies or health/behavioural notes? *

Shirt Size (For full week summer camp registrations only)

Emergency Contact Name (First & Last) *

Emergency Contact Phone Number *

Preferred Email for Communications *

Secondary Emergency Contact Name (First & Last) *

Secondary Emergency Contact Phone Number *

Authorized Pick-Up Person(s) (Full name & relationship to participant) *

Please let us know who is allowed to pick up this participant.

I hereby agree that Art with HEART Studio, its staff and agents shall not be held liable for any injury, loss or damage to my child or my child's property, including deterioration of health. I understand that all registrants are expected to participate in all activities each day they attend classes. If my child has a temporary restriction (i.e: flu, allergy, fever) I agree to inform the program contact person in advance of the daily activities. Every effort will be made to contact parents and/or guardians when an injury has occurred. Art with Heart may decline a participant due to physical and or/verbal abuse towards staff and other participants. In the case of any bullying situations, parents or guardians of all parties involved will be notified. I declare having read and understood the above-informed consent agreement in its entirety and hereby give my consent for the registrant to participate knowing all of the foregoing. *

I Agree

Photo/Video Consent: I hereby grant permission for video recordings and digital photographs to be taken of my child or my child’s work as a part of their participation in Art with HEART Studio (AWHS) programs. I release and assign permission to license all videos and images and to use all videos and images in any media (website, social media, print, etc.) for purposes which include, among others, advertising, promotion, marketing, and packaging. I understand that any videos or images may be combined with other images, text and graphics, cropped, altered and modified. I agree AWHS has all rights to images and videos for perpetuity. *

I consent
I do not consent

Notes/Comments

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GENERAL REGISTRATION FORM!