Art Buzz Kids After School Art Club
Art Buzz Kids is a division of Wine & Design



provide email address to be used as primary form of communication
Email address *
Thank you for registering your child for the after school art club with Art Buzz Kids. Our wildly popular art classes are a great way for your kids to unplug and get creative. Students will create canvas paintings, DIY projects, wood projects, mixed media, everything to inspire your artists to be as creative as they wish to be.
Fall Session: August 20th- Dec17th 2019 *No Class on School Holidays or Minimum Days
Fee: $450 Plus $85 material fee
Please note, your child's space in class is not confirmed until you have made payment through www.paypal.me/wndlosaltos for the total of $450 plus $85. We also accept checks. Please contact us for instructions if you plan to write a check losaltos.ca@wineanddesign.com
Cancellation Policy: We are happy to issue a credit towards future classes only. No Refunds. But you are welcome to try a class before you sign up. Please contact us at losaltos.ca@wineanddesign.com if you would like to try a complimentary class.
Student Name (First and Last Name) *
Your answer
Grade *
Teacher's Name and Room # *
Your answer
Parent or Guardian Name *
Your answer
Parent or Guardian Phone # (Cell or best contact number) *
Your answer
Parent or Guardian Alternate Phone #
Your answer
Emergency Contact: At least one adult OTHER THAN parent/guardian, who is authorized to pick up child. Please list NAME and RELATIONSHIP to child. *
Your answer
Emergency Contact Phone # *
Your answer
Does your student have any allergies? *
If "Yes" please specify:
Your answer
Please send a NUT FREE snack with your child to eat before class starts. By checking the box below, you understand that Art Buzz Kids after school art club is a NUT FREE zone and you agree not to send anything containing nuts with your child. *
Required
We require parents to come sign out their kids after class. If your child is allowed to walk/ride home by him/herself and you would like us to discharge your child from Art Class without signing out, please indicate"yes" below. child out? If your child goes to after school care please specify in notes below. *
Required
Please be sure to pick up promptly at class end time. By checking the box below, you understand and agree that there is a $10 late fee charged for every 15 minutes late to pick up. *
Required
By checking the box below, you understand that in some classes we may be using paints or other substances which could be permanent and may stain clothing. You agree to not hold Art Buzz Kids, a division of Wine & Design, or any of its representatives and/or staff liable for any damages. *
Required
Art Buzz Kids posts occasional photos of art classes on social media. By marking "Yes" you allow your child to be photographed in a classroom setting and possibly posted on social media.
Emergency Medical Release: PLEASE READ CAREFULLY and AGREE with the statement below *In the event of injury or serious illness, you give permission for Art Buzz Kids, a division of Wine & Design, or a representative or staff to obtain medical treatment for your child. You understand that if your child needs to be transported to an emergency facility, that decision will be made by the emergency team responding to the call, school staff or Art Buzz Kids staff, for the safety and well being of your child. *
Required
You agree to waive, release, and discharge Art Buzz Kids, a division of Wine & Design, and any of its representatives or staff, of any and all liability of any incident that may occur at or once your child leaves the premises. By digitally signing this document, you certify that you have read and fully understand this document and its contents and you allow your child to participate in this after school art program. Your name below represents a digital signature, which is valid as a handwritten signature. *
Your answer
You understand that your child's space in the class is not confirmed until you make the payment through www.paypal.me/wndlosaltos or by check. *
Any other info we should know..... does your child get picked up by a different caregiver? Does your child go to after school care, please specify....
Your answer
Art Buzz Kids is a division of Wine & Design
630 Fremont Ave. Los Altos, CA 94024 | 650-880-7872 | losaltos.ca@wineanddesign.com
www.wineanddesign.com/losaltos
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Wine & Design. Report Abuse - Terms of Service