Gallery Kids Sign Up Form - March 10, 10:30 a.m. - 12 p.m.
Please sign up your 8-15 year old for the next Gallery Kids Event. On March 10th we will explore the fiber art exhibition entitled "The Wonder Makers Collective." Participants will create their own embroidery hoop art using these bright and funky works of art as inspiration!
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).
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.
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