KidsArt Information Form

KidsArt Information Form This form provides the information we need for your student/s to attend KidsArt Classes. It does not register them in a class.

Student Information

Student 1 First Name *

Student 1 Last Name *

Student 1 Age *

As of May 31, 2023

Student 2 First Name

Student 2 Last Name

Student 2 Age

As of May 31, 2023

Student 3 First Name

Student 3 Last Name

Student 3 Age

As of May 31, 2023

Parent/Guardian Name *

Address *

Country

City

State

Zip code

Phone *

Work Phone

Email *

Emergency Contact, Release Form and Pick-up Authorization

1st Parent/Guardian Name *

Phone *

2nd Parent/Guardian Name

Phone

Other

Phone

Not Authorized

Doctor's Name, Preferred Hospital

Doctor's Name

Preferred Hospital

Doctor's Phone

Allergies, Medical Conditions

Student 1 Allergies

Student 2 Allergies

Student 3 Allergies

Policies: Please Read and Agree

I have read and agree to these policies

• A $100 deposit is due at the time of registration. Classes less than $100 must be paid in full 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. • Children must be age 6 & have attended kindergarten to register for Marvelous Mondays, Talented Tuesdays, and KidsArt. • 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/guardian to remove their child from the ArtCenter 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.

Photo Release *

Yes

I hereby give permission for images of my child captured during KidsArt Camp or After School Programs through video, photo or digital camera, to be used solely for the purpose of promoting ArtCenter Manatee programs. I waive any rights of compensation or ownership thereto.

Liability The signature below of an authorized parent or guardian of the registered child/children acknowledges and accepts the conditions of payment and ArtCenter Manatee Policies as stated above, in the brochure, catalog and online. We also authorize 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 Parent/s or Guardian/s or other Emergency contacts.

Parent/Guardian Signature *

Please enter your first and last name.

Date *

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KidsArt Information Form

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