Gallery Kids Sign Up Form - March 7, 10:30 a.m. - 12 p.m. (Location: UCM Art Center)
Sign up here for the next Gallery Kids Event. Participants will see the textile art work of C. Pazia Mannella and participate in the weaving process!  Where does cloth come from?  How can we make our own looms?  What is the warp? What is the weft?  Find out the answers to these questions at the March 7th Gallery Kids event at the UCM Art Center! (E. Clark Street at S. Maguire, 64093) Parking is free on Saturdays across the street in Faculty Lot 10. Recommended for ages 6-15. Limit of 15 participants.
Email address *
Child's Name *
First Last
Your answer
Child's Age (Must by 8+) *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Parent or Guardian Name *
Your answer
Telephone No. *
Your answer
Person(s) Permitted to Pickup Child *
Your answer
In Case of Emergency *
If for some reason we cannot reach a parent or guardian, who can we call in the unlikely case of an emergency? (Name and telephone no.)
Your answer
Special Instructions or Areas of Concern
Does you child have any special needs we need to know about?
Your answer
Emergency Medical Authorization *
This EMERGENCY MEDICAL AUTHORIZATION AND RELEASE hereby authorizes personnel of the UCM Department of Art & Design to make emergency medical decisions as to illness and/or injury which my child(ren) may develop or sustain as part of this program’s activities. Said personnel shall make all reasonable efforts to contact me(us) as parent(s) prior to authorizing any medical treatment, but may authorize such medical treatment in what the authorized person believes to be the best interests of said child(ren).
Required
We'd like to make photographs of the GALLERY KIDS in action! May we take your child's picture and use it for promotional purposes only? Images will not be sold or used outside of UCM. Plus, we'll email you copies of the pictures we take during class!
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 University of Central Missouri. Report Abuse