Please Print form and return with payment to:
ArtCenter Manatee
209 9th Street West
Bradenton, FL 34205
941-746-2862
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Student’s Name  Age
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Parent/Guardian’s Name
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Child’s School
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Home Address
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City State Zip
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Phone
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Work Cell
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Email
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Name(s) of other sibling(s) registered for camp.
Please complete one release and registration form for each child.
I hereby allow ArtCenter Manatee to take photographs of my child/children to be used for the
ArtCenter public relations and archival purposes only.
____Yes _____No
Liability Release
In regards to the student named above, I, the undersigned parent or legal guardian, do hereby release
ArtCenter Manatee, or any persons acting on its behalf from liability for any bodily injury sustained,
or loss or damage of any personal article, while on the premises participating in any activity.
Furthermore, the undersigned agrees that in the event that medical attention is required, ArtCenter
Manatee shall be permitted to seek such medical services as it shall deem necessary and appropriate
through EMS/911 and/or local hospitals.
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Signature/ Date
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Contact in case of emergency
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