MULTI-ARTS One day workshop
Join Multi-Arts' educational and artistic program January 17, 2020
At Immanuel Lutheran Church, 867 North Pleasant Street in Amherst.
Email address *
Child's Last Name
Your answer
Child's First Name *
Your answer
Child's age *
Your answer
Sex *
Parent/Guardian Name and cell phone *
Your answer
Phone to call in case of an emergency *
Your answer
Does child has any life threatening allergies?
Your answer
Is there any information staff should know to help your child have a successful and fun day?
Your answer
“I give the Director and staff of the Multi-Arts Program permission to administer minor first aid to my child. Should more than a minor injury occurs, requiring emergency treatment, I give permission to the Director and staff to acquire emergency medical treatment (i.e. ambulance)”. *
Our pictures are a testimony of the rich environment your child enjoys at Multi-Arts and may stimulate a conversation with your child about their social and artistic experiences. These pictures are also an important means to promote Multi-Arts. I respectfully ask you to read and sign the following authorization. I grant Multi-Arts permission to take photographs and/or videotape my child during the program’s activities. I understand that these may be used in future brochures, publicity materials, and on the website. The name of your child will not appear with the images. No profit will be made from the images. *
Fee for one day workshop is $75 per child. You can either mail in a check to Multi-Arts, PO Box 108, Hadley MA 01035 or pay online via Paypal *
Please be sure to accept emails coming from:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy