T. W. Wood Gallery 2019-2020 After School Arts
Afterschool Arts Program runs Monday thru Friday beginning Tuesday September 3rd 2019 until Thursday June 18th 2020 and otherwise follows the 2019-2020 Montpelier school calendar including closures for weather.

T.W. Wood Gallery; 46 Barre St., Montpelier, VT 05602; in the Center for Arts & Learning; 802-262-6035;
Email: info@twwoodgallery.org; Website: www.twwoodgallery.org
Email address *
Parent or Guardian Name (1): *
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Parent or Guardian Name (2):
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Student 1 Name: *
Your answer
Student 1 Birthdate: *
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Student 1 Grade: *
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Student M/F: *
Student 2 Name:
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Student 2 Birthdate:
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YYYY
Student 2 Grade:
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Student 2 M/F:
Address Information:
Street: *
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Street 2:
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Town: *
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State: *
Required
Zip Code *
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Phone # 1 *
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Phone # 1 - Cell
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Phone # 2
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Phone # 2 - Cell
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AfterSchool Arts Information
• Drop-off time is between 3:00pm & 3:15pm. Pick-up time is no later than 5:30pm.
The monthly rate is constant without compensation for weather closures, vacations, holidays, or absences.
• Late pick-up fee for repeated incidents is $10.00 with an additional $5.00 for every 15 minutes after 5:45pm
• One month advance notice is required for contract changes.
• The Program Director, Ellis Jacobson, must be notified in advance of any absences or late arrivals by emailing
afterschoolarts.twwood@gmail.com or calling the Gallery at 802-262- 6035.
Check Afterschool Arts Schedule You Are Registering For: *
Select days to attend *
Required
I understand that:
• Children should bring a daily snack and appropriate outdoor clothing for the weather. A paint shirt is recommended.
• No child will be allowed to be picked-up by an adult other than a parent unless previously communicated to the program director.
• A student may be released from the program if behavior is inconsistent with teacher expectations and safety concerns on a repeated basis.
RELEASE: I hereby give permission for my child to participate in the After School Arts Program. I assume all risks and hazards, incidental to such participation. I hereby waive, release, absolve, indemnify, and agree to hold harmless the T. W. Wood Gallery and the After School Arts Program, their officers, agents, officials, employees, volunteers, the organizers, sponsors, supervisors and participants for any claim arising out of an injury to my child. *
Medical Care Permission:
Attention: So we may best serve all students, if a child has a dedicated one-on-one para professional assisting during the regular school year, please arrange for the full-time aide to similarly assist during afterschool arts.
The T.W. Wood Gallery Afterschool Arts staff has my permission, in an emergency, to obtain medical care for student 1 (Checking YES confirms authorization): *
Required
The T.W. Wood Gallery Afterschool Arts staff has my permission, in an emergency, to obtain medical care for student 2(Checking YES confirms authorization): *
Required
Please list Emergency Contacts - in order of preference and best way to reach quickly via phone:
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Please list your child's doctor and contact information below.
Your answer
Please list any food allergies, medical requirement or restrictions (write None if there are not any issues)I agree to notify the Afterschool Program if there are any changes in medical information: *
Your answer
MEDICAL RELEASE: I authorize The T. W. Wood Gallery After School Arts Program to act in the place of parents or guardians of the student should any emergency medical or surgical treatment or hospitalization be required during the time this student is enrolled in the Program. It is understood that the Program and hospital authorities will make every effort to contact the parents or the Emergency Contact below before acting on this authorization. *
T.W. Wood Student Transportation Information:
This information pertaining to walking, biking home independently or if another person(s) has permission for pick up.
Please authorize if your child(ren) are permitted to walk or bike home independently. *
Required
Please authorize other people allowed to pick up for child(ren) at the end of the day (if no one, write None):
Your answer
If offered, would you like your child to be walked by an adult from school to the gallery for a small additional fee? *
T.W. Wood Photography of Afterschool Arts:
Please authorize if the gallery can take photographs/video of my child(ren) during Afterschool Arts for archival, publicity and social media purposes: *
Required
Afterschool Arts Fees and Payment: Monthly rate is due on the first of the month.
Payment via: *
Credit Card Payment: Please write credit card number, name on card, security code below. If you prefer - you may call or stop by the gallery with your information. Please submit form in either case.
Your answer
Thank you! We look forward to After School Arts with you!
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