Please print and mail this Registration Form: Celebrate ART Class/Camp Registration Form Student's Name:_________________________________________________________________________  DOB:______________________ Parent's Name: Mother:___________________________________________  Father:___________________________________________ Address:_______________________________________________________  City:_________________________ Zip:__________________ Home Phone:(____)______-__________   Alt. Phone:(____)______-__________ Email:______________________________________________________________________________________________________________ Allergies, medical or dietary restrictions:_______________________________________________________________________________ Emergency Contact Information Name:_______________________________________________________________________  Relationship:________________________ Daytime Phone:(____)______-__________   Alt. Phone:(____)______-__________ Class/Camp Enrollment Information Class & Time:_____________________________________________________________________________________   $____________ Class & Time:_____________________________________________________________________________________   $____________ All Classes/Camps held at: Celebrate ART 1023-B Chestnut St., Redwood City, CA. For more info call us at (650)293-1374 Make checks payable to: Celebrate ART Mail to: 1023-B Chestnut St., Redwood City, CA. 94063 Paypal Users: When submitting your Paypal payment, please use the following email address: Ginger@CelebrateArtNow.com Please print this form and mail along with your payment Email confirmation will be sent within five business days of receipt of registration Waiver I hereby agree to hold Celebrate Art (CA), their program and instructors, harmless from all liability which may arise as a result of participation in class activities. I hereby give my permission for my child to participate in the activities listed above and also agree to hold CA, their program and instructors, harmless from all liability which may arise as a result of said minor's participation in such activities. I understand that the activities may involve risk, accidental injury, soiling of clothes, or other incidents and hereby voluntarily assume such risks. I give consent for CA or assignees to use my photograph or photographs of art made at CA in any manner or form or for any medium without restriction or limit for the purposes of nationwide publicity, advertising or display. I understand that I will receive no payment or compensation for this permission. ( If participant is a minor, a parent or guardian must sign below.) I have read and understand the above information. (Parent/Guardian) Signature:_______________________________________________ Date:_____________________