After-School
Art Enrichment
Student Check-In Form

Thanks for booking with us!

Please fill out the form below for your child. It includes important contact and safety information. Thank you!

School

Student's Name

Allergies

Accommodations

Parent

Phone

Emergency

Emergency phone

PLEASE CHECK IF CHILD IS TO TRANSFER TO YMCA

I understand that the adults authorized to pick up my child must present a valid photo ID

Authorized adult

Relationship

Cell Phone

PERMISSION TO PARTICIPATE: I, the undersigned, consent for my monor child/ward to participate in the programs sponsored by The Art Center. In consideration of my monor child's/ward's participation and do further agree to release, absolve, indemnify and otherwise hold harmless The Art Center, it's employees, administrators, agents and assigns and others who assist the above for any loss, damages or personal injuries that my child/ward may receive as a result of such participation.

MEDICAL CONSENT: I understand that there are some risks inherent in the activities that are included in the Program, but willingly assume these risks in order to allow me, my child/ward to participate and I give permission for any emergency medical care or treatment by a physician, surgeon, hospital nurse, doctor's assistant or medical care facility that my be required. The parent will be responsible for incurring all assiciated financial costs.

The Art Center After School Enrichment Program may not be appropriate for children with known behavioral conditions. If a student consistently disrupts the learning of other students, The Art Center reserves the right to remove the student from the program. A prorated refund will be issued.

PHOTOGRAPHY Students are often photographed to document The Art Center's programs and to generate images for use in promotional material and social media. If you do not wish for your child to be photographed, please uncheck and notify The Art Center Staff

PICK UP Must be made by 4:00PM unless your child is registered for YMCA. A fee of $15.00 will be charged for pick ups later than 4:00 PM.

Parent Signature

The Art Center is independent from the elementary school. If you have any questions regarding the After School Art Enrichment class, please contact The Art Center 770-623-8448. Any questions regarding dismissal or buses please contact your school's front desk.

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After-School Art Enrichment Student Check-In Form

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After-School
Art Enrichment
Student Check-In Form