Student Art Lab Registration and Consent Form

Student Art Lab Registration & Consent
Enter student, parent/guardian, and emergency details, then review and sign consent, medical, and media release information.
Student Information
Student Name
First NameLast Name
Birth Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade
Student Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information
Parent/Guardian Name
First NameLast Name
Home Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact Name
First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies, Chronic Illness, or Other Medical Conditions
Inhaler Instructions (if prescribed)
Consent, Waivers, Signature, and Verification
Consent and Waiver Terms
Electronic Signature
Powered by Jotform SignClear
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Consent to Email Communications
Event Selection and Payment

Sept 11, 10-12 — Desert Art Lab

Desert Art Lab session

$50.00

Sept 18, 10-12 — Forest Art Lab

Forest Art Lab session

$50.00

Total

Student Art Lab Registration & Consent