Painting Workshop Registration Form

ALABASTER ARTWORK
Part Art Studio-Part Kids Place
Old Mandeville LA 70448
7 blocks from Girod St. & Hwy.59
985/502-7250
www.alabasterartwork.com
email: alabasterartwork@yahoo.com


Painting Workshop Registration Form--$20 per event
Child’s name: ______________________________
Phone : ______________________
Address: _____________________________
City /Zip: ________________________
Grade level: _____ School: ______________________ Age:_____ Male or Female
Email address: _________________________________
Date of Birth:_______________
List any previous art classes taken & age/grade of child: ___________________________
I am registering for dates (circle that apply): Thurs. June 26--Just Ducky 1pm-3pm (ages 4-up)
Sat. June 28--Hoppy Face 10am-12noon(ages 4-up)
How did you hear about Alabaster? ___________________________________________
Parent’s name____________________________
Cell phone: ______________________
Alternate contact in case of emergency: ________________________________________
Relationship: _____________________
Phone: _________________________________
List any allergies or disabilities your child may have____________________________________________________________________
Child lives with ___ both parents ___ father ___ mother ___ guardian: _______________
If parents are separated or divorced, who has legal custody?_________________________
Name of person(s) other than parent allowed to pick up child(ren):
_______________________________________________________________________
PARENT’S AGREEMENT
I agree to all of the terms given in this agreement and I understand it is a legal document. I give permission to Alabaster Artwork and Elizabeth Winters serving as Director to care for my child during the time he/she is on premises and to secure emergency medical care for my child if Alabaster Artwork is unable to reach me.
Child’s Doctor: ____________________ Phone: ________________________
Parent’s Signature: ________________________________
Date: ____________