Student Registration Form

First name

Last name

Phone

Class Day and Time:

Student Age and Grade:

Guardian First and Last Name:

Guardian Phone Number:

Guardian Email Address:

Guardian First and Last Name:

Guardian Phone Number:

Guardian Email Address:

Please provide info. About individuals your child has permission to go home with, names and relationships, any information that is helpful including any physical limitations/ restrictions, allergies, medical conditions to be aware of:

Photo Authorization:

Photos of me/my child and my/their artwork

Photos of my/their artwork only

No photos

Pricing Agreement:

Pay $120.00 a month

Pay by semester

Private Lesson

Other

Month to month schedules will be communicated beforehand. Payments are due on the first class of the month. We closely but not entirely follow the LSSD school calendar for holidays as well as inclement weather; any info on closure will be communicated appropriately.

I understand that children will be supervised at all times, at no point will a child be left in the studio unattended. However, in case of an accident resulting in illness or injury I, the parent/guardian of the student listed above, agree to take responsibility for any medical bills that may incur. I release the instructor of the art classes from liability and/or claims or damages arising out of personal injury/illness of any kind including COVID-19. If necessary, I authorize the art instructor of art classes to administer first aid and/or authorize medical treatment for me or my child.

Signature

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Date: