Multi-Arts Spring Program 2019
APRIL VACATION program :: APRIL 15- 19
Register for: *
Number of Days of Attendance *
Specify Days of Attendance *
Required
Child's First Name *
Your answer
Child's Last Name *
Your answer
Age *
Your answer
Date of birth *
Your answer
Sex *
Parent / guardian name #1 *
Your answer
E-mail address *
Your answer
Cell phone *
Your answer
Optional: home phone
Your answer
Optional :work phone
Your answer
Optional: Address
Your answer
Best way to contact in an emergency *
Optional: Parent/guardian #2
Your answer
Optional: e-mail address
Your answer
Optional: Cell phone
Your answer
Emergency Contact name and phone number *
Your answer
Does child has any life threatening allergies? *
Your answer
“I give the Director and staff of the Multi-Arts Program permission to administer minor first aid to my child and if injured and requires emergency treatment, I give permission to the Director and staff to acquire emergency medical treatment (i.e. ambulance)”. *
Required
I give permission to Multi-Arts to take photographs and/ or videotapes of my children that may be used in future brochures/ publicity materials and on the Multi-Arts website. No profit will be made from these recordings, and the names of the children will not appear next to the images. *
Your answer
How did you learn about this program: *
If you answered "OTHER", please, specify: *
Your answer
Payment Method *
You can either mail in a check or pay online via Paypal http://www.multi-arts.org/payment.html
Submit and pay online: http://www.multi-arts.org/payment.html or send full payment of tuition to Multi-Arts - PO Box 108 - Hadley, MA 01035.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service