Name of Student: *

First Name

Last Name

Parents or Guardian Name (if applicable):

First Name

Last Name

Student Date of Birth: *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (home) *

(###)

###

####

Phone (mobile) *

(###)

###

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Emergency Contact: *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Parental Consent (required for students under 18)

As guardian and/or parent, I understand that I assume full responsibility for my child’s arrival and departure to and from The Art Room. I understand that The Art Room shall bear no responsibility for the means by which my child arrives at or departs.

Agree

Liability Agreement *

I waive all rights to any legal action against The Art Room or it’s instructors in the event of injury, damages, loss of personal property not caused by or resulting from the negligence of the owner or operators, employees or persons in charge of The Art Room.

Agree

Photography Release *

I consent to and authorize the use and reproduction by The Art Room or anyone authorized by The Art Room of any and all photographs that have been taken of me (if Student) or my child without compensation to me. All photo images are owned by The Art Room. The Art Room reserves the right to use these photographs in any of its print or electronic publications. I hereby acknowledge that I have read and understood the terms of this release.

Agree

Right to Refuse Service *

I understand that The Art Room reserves the right to refuse service to any student for reasons such as, but not limited to, disruptive or unsafe behavior, or behavior unsuitable for the comfort of the classroom environment.

Agree