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

Month to month schedules will be communicated beforehand. 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: