Name *

First Name

Last Name

Session Date *

MM

DD

YYYY

Phone *

Please enter in US format (eg 000 000 0000)

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone

(###)

###

####

If you require postage please fill out the address form below

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Release agreement for artists: *

If completing this form as part of a private group booking, I consent to on behalf of the group

Photos: I authorise my arts / crafts to be displayed in the gallery, and that it and myself may be photographed for promotion purposes. (if you object, please let your instructor know prior to commencement)

I agree to the fullest extent to be responsible for any medical bills, which may incur resulting from illness or injury during my participation in art classes. I understand and agree that I am expected to carry accident and medical insurance. I release the instructor of the art classes from any and all liability ad / or claims and /or damages arising out of personal injury of any kind. If necessary, I authorize the art instructor of art classes to administer first aid and / or authorise medical treatment for me.