Student First and Last Name *

Student Age *

Parent/Guardian First and Last Name *

Parent/Guardian Phone number *

Parent/Guardian Email *

Address (we use this to send thank you and holiday cards to our students)

What package are you Registering for?

What is your goal with our lessons? *

We will be using Zoom for our classes. Your student will need either a computer or a phone with a camera and microphone. *

All Payments can be made through Paypal. Link: Paypal.Me/icecollab *

Media Consent: By selecting the "Agree to Media Consent" you are as Legal Guardian or Parent of registering Student providing Imagine, Create, Explore Collaborative Arts permission to use my images (still or video) of my Student from images taken in class or during performances for all advertising and promotional materials, including, but not limited to, print, Facebook, Twitter, other social media platforms and the company website. Imagine, Create, Explore will not use last names but may use students first name, age, character names, quotes, photograph and video, and written work. We will only use Student's name on T-shirts and Programs. *

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