Celebrate ART Email Registration Form

Student's Name:

Date of Birth:

Parent's Names: Mother:   Father:

Address:

City:   Zip:

Home Phone:   Alt. Phone:

Email: * (required for class confirmation)

Allergies, medical or dietary restrictions:


Emergency Contact Information

Name:   Relationship:

Daytime Phone:   Alt. Phone:


Class/Camp Enrollment Information

Class/Camp & Time:    $

Class/Camp & Time:    $

Payment Method:     Paypal     Check     * (required)

Comments:

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

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.     * (required)