Summer Art Academy Registration Form

Family Contact Information

Please complete all information.

Father/Guardian Name

Mother/Guardian Name

Address 1

Address 2

City

State/Province

Zip

Primary Phone

Phone Type

Secondary Phone

Phone Type 2

Emergency Contact (not parent)

Emergency contact relation to student(s)

Emergency Contact Phone

Who drives student(s) to class

Parent's Email

Student 1

Student 1 Name

Student 1 Birth Date

Student 1 Current Grade/School System

Student 1 Cell Phone Number (if applicable)

Student 1 Special Medical/Health Factors

Student 1, please choose your class time... *

Student 1 T-Shirt Size

Student 2

Student 2 Name

Student 2 Birth Date

Student 2 Current Grade/School System

Student 2 Cell Phone Number (if applicable)

Student 2 Special Medical/Health Factors

Student 2, please choose your class time...

Student 2 T-Shirt Size

Student 3

Student 3 Name

Student 3 Birth Date

Student 3 Current Grade/School System

Student 3 Cell Phone Number (if applicable)

Student 3 Special Medical/Health Factors

Student 3, please choose your class time...

Student 3 T-Shirt Size

Waiver

I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen by nature of the physical, athletic activity engaged in while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage. I understand that the art of theater/dance and nature of dance and theater instruction may sometimes require a teacher to touch students. I also understand that this will happen in a respectful, gentle and appropriate manner. I understand, further, that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc. I understand Creative Arts will add my contact information to email campaign/text messaging software in order to communicate information to me about Creative Arts programming. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time. I agree to pay tuition in full at the time of this registration in order for my spot(s) to be held. I understand tuition is non-refundable. By checking the box below, I agree to the above listed terms and conditions established by the Creative Arts Council of Wells County, and acknowledge that checking this box will act as a digital signature.

I agree

Please note: Tuition Payment options will be sent out in the email confirmation you receive when you click on the "Register Now" button below.