ART & MUSIC CLASS REGISTRATION FORM
Child’s Name and Age:
Your answer
What day/time do you prefer for your class?
Your answer
Guardian Name, email address and cell phone number
Your answer
Additional Guardian Name, email address and cell phone number
Your answer
Emergency Care Information: Allergies/Medical Info:
Your answer
Name and phone # of Emergency contact if Parent is unavailable:
Your answer
Release of Liability: As the legal parent or guardian, I release and hold harmless Main Street School of the Arts, its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Main Street School of the Arts, its owners and operators or in route to or from any of said premises. This program is exempt from Bright From the Start licensure. I've read the above and agree –please type signature:
Your answer
May I use a photo of your child for promotional materials?
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