STepSTone Arts Program Registration Form
Email address *
A deposit of 1/2 the entire fee is required at time of registration (including a non-refundable admin fee of $50) to guarantee space. Once you submit an application, Please schedule a telephone interview by emailing theartizencompany@gmail.com as soon as possible. *
Confirm understanding of this policy. If "NO," please email theartizencompny@gmail.com or call 770-771-4863 with your questions.
How did you hear about this workshop? *
(Please be specific.)
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Workshop Title *
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When does workshop begin? *
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First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Parent Name *
Your answer
Best Contact *
Your answer
Home phone
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Work
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Cell
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Street Address *
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Apt. #
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City *
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State *
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Zipcode *
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Email Address *
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Emergency Contact Name *
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Emergency Contact Tel. *
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Emergency Contact Relationship *
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Tuition Fee *
Your answer
Discount with promo code
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Method of Payment *
Your answer
WAIVER: I, [give permission for my child,]______________________[to]/will participate in this workshop. I understand that safety precautions will be taken during all activities. In the event that an accident does occur, I will not hold The Artizen Company, its employees or volunteers responsible for any accidental injuries. If emergency treatment or advice is considered necessary by The Artizen Company staff, I understand that the listed physician [and parent/guardian] will be notified. If we cannot be reached, I authorize The Artizen Company to arrange whatever emergency treatment is considered necessary. *
(Enter your child's name)
Your answer
*Please list any medical conditions The Artizen Company staff should know of. *
(Including biological, behavioral, or emotional, etc.)
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Physician's Name
(If known)
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Physician's Contact information
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Hospital
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Electronic Signature *
(Enter your name here.) You will need to provide actual signature before workshop begins.
Your answer
Date Signed *
MM
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DD
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YYYY
Would you like to pay online? *
Only if paying for full tuition. Deposits must be mailed or paid in person.
Online Store: Enter amount paid online
Your answer
Need-based scholarship funds are available to subsidise tuition for exceptional candidates. Please consider making a donation to help tuition assistance for summer session 2016. You can make a difference with
ALL DONATIONS WELCOME! Please visit www.theartizencompany.com
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