Art Center Manatee
Application will not be complete until this form is returned. Since students attending the camp are under 18 years of age, it is necessary that our teachers and/or administrators have the parents’ permission to administer treatment in the event of an accident or sudden illness.
Student Medical Information:
Student's Name: Date of last tetanus immunization:
Any allergies to medicines: If so please list:


Any conditions that physicians should be aware:


Emergency daytime phone:  

I hearby authorize any medical treatment which may be advised or recommended by the attending physician of:
Parent or Guardian Signature


The undersigned hereby acknowledge that participation in this camp and related activities involves an inherent risk of physical injury, and the undersigned, on behalf of the registrant, hereby assumes all risk and does hereby release and forever discharge ArtCenter Manatee and all employees and agents thereof from any and all liability of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, damage to property, and the consequences thereof, resulting from the registrant’s participation in or involvement with this camp, including any failure of equipment or defect in the premises.

I hereby state that I am the legal guardian of said child.

Parent or Guardian Signature and Date


Signature of Witness and Date
Student Class Registration Information:
Student's Name: Age:
Name of School:
Home Address:
City: State: Zip:
Home Phone: Work Phone: E-Mail:
Please enroll my child in following Kids Summer Art class/es:
Class 1: $
Class 2: $
Class 3: $
Total Class Tuition  $
ArtCenter Manatee Membership: $ 20 Student, $70 Family $
Balance Due  $

Method of Payment:
Cash I will be sending a Check Please call me for Credit Card info


PHOTO and LIABILITY RELEASE
for KIDSART and SPROUTING ARTISTS
Print out form and fill out


____________________________________________________________________________
Students Name and Age

____________________________________________________________________________
Parent/Guardian’s Name

Photo Release
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.

____________________________________________________________________________
Signature/ Date

____________________________________________________________________________
Contact in case of emergency

____________________________________________________________________________
Day       Cell       Evening Phone

Please return form and payment to: ArtCenter Manatee
209 9th Street West
Bradenton, FL 34205
941-746-2862
Email ArtCenter Manatee