Earth: Heart and Art! - April 20 - 24, 2020, 9am-3pm, Aftercare available (3-5pm)- TW Wood Gallery
Taught by Linda Hogan

A joyous celebration of creativity and earth for Earth Day! This week the earth is our creative inspiration!
Ages 7-12

Cost: Week Long: Non-member $300, Members: $285
One Day: $65 ($60 for members)
Aftercare: 3-5pm: $10 per day
Take $10 off the total price for second and third child attending from your family
Email address *
Student 1 Name: *
Your answer
Student 1 Birthdate and grade: *
Your answer
Student M/F: *
Student 2 Name:
Your answer
Student 2 Birthdate and grade:
Your answer
Student 2 M/F:
Parent(s) / Guardian first and last names: *
Your answer
FULL ADDRESS: *
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Phone and Cell: *
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After Care
Days Attending
RELEASE: I hereby give permission for my child to participate in the TW Wood Gallery - Children and Family Arts Programs. 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 Children and Family 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 any Children and Family Programming.
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 any food allergies, medical requirement or restrictions (write None if there are not any issues)I agree to notify the TW Wood Gallery if there are any changes in medical information: *
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Please list Emergency Contacts by preference and how to reach quickly by phone.
Your answer
Please list children's doctor and contact information.
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MEDICAL RELEASE: I authorize The T. W. Wood Gallery and their Children and Family Programs 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 pertains 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
T.W. Wood Photography of Afterschool Arts:
Please authorize if the gallery can take photographs/video of my child(ren) during Children and Family Programming for archival, publicity and social media purposes: *
Required
Payment via: *
Credit Card Payment : enter credit card number, full name on card, date, 3 digit security code. Or optionally - call the gallery to provide information via phone or in person. (Please submit form for whichever method you choose)
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Thank you! We look forward to Children and Family Programming with you! For any questions / comments please contact the Gallery: 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
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