KidsArt Registration Online Student InfoStudent 1 Name and Age *Student Name and Age as of May 31, 2021 Student 2 Name and Age Student Name and Age as of May 31, 2021 Student 3 Name and Age Student Name and Age as of May 31, 2021 Parent/Guardian Name * Home Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Phone * Work Phone Email * Emergency Contact, Release Form and Pick-up Authorization1st Parent/Guardian Name * Phone *1st Parent/Guardian Phone 2nd Parent/Guardian Name Phone 2nd Parent/Guardian Phone Other Name Phone Other Name Phone List below those NOT authorized to pick up student/sName 1 Name 2 Doctor's Name, Preferred HospitalDoctor's Name * Doctor's Phone * Preferred Hospital Allergies, Medical ConditionsStudent 1 Allergies If none, write none Student 2 Allergies If none, write none Student 3 Allergies If none, write none Policies. Please Read and AgreePolicies *POLICIES – PLEASE READ Following CDC guidelines, those who are fully vaccinated are no longer required to wear face coverings inside the building. Those who are not fully vaccinated are required to use face coverings over their noses and mouths." Thank you for your cooperation. • A $50 deposit is due at the time of registration. The balance for each session is due the week prior to the start date of the session. Registration will be forfeited if full payment is not received at least a week prior to the session. • There are no refunds for class cancellations & funds may not be transferred to a different class or session. There are no makeup classes. • Staff & instructors at ArtCenter Manatee will not be responsible for administering over the counter or prescription drugs to students. • In fairness to all, disruptive behavior will not be tolerated during camp for any reason. We reserve the right to ask a parent or guardian to remove their child from ArtCenter Manatee without benefit of a refund or monies paid for any/all camp sessions. • Drop off of your child is no earlier than 8:45am. If enrolled in aftercare, pick up time is no later than 5:00pm. • Personal items such as music devices, cell phones, etc. are not permitted in class.I have read and agree to these policies Photo ReleasePhoto Release *I hereby give permission for images of my child, captured during Kid's Art activities through video, photo and digital camera, to be used solely for the purposes of ArtCenter Manatee promotional material and publications, and waive any rights of compensation or ownership thereto.YesNo Liability The signature below of an authorized parent or guardian of the registered child/children acknowledges and accepts the conditions of payment and the ArtCenter Manatee Policies as stated above and in KidsArt Brochure. We also authorize the ArtCenter Manatee staff to contact, consult and authorize emergency treatment if required, with the above named physician (or other professional medical personnel, such as EMS services) in the case of inability to reach any of the above named Parents, Guardians or other Emergency contact. Parent/GuardianSignature *Please type your first and last names VerificationPlease enter any two digits (no spaces)This box is for spam protection - please leave it blank
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