AL Studio Art Camp Registration Form
www.artclasskirkland.com
Student
First Name
Last Name
(425) 908.9908
Gender
1425 Market Street, Kirkland WA 98033
Age
Home Address
Parent/guardian 1
Name
Home/Cell Phone
Email
Parent/guardian 2
Name
Home/Cell Phone
Email
Camp date & time
Allergy or other health concerns:
1. I give permission for my child/children to participate in the art camp program at AL Studio, I understand this is
not a day care program.
2. In consideration of these opportunities, I assume all risks incidental to such participation. Neither AL Studio,
nor their employees, chaperones, or teachers shall be held financially responsible or liable for any injuries that
may occur.
3. Photo Release
I understand and give permission for art work photos of my child/children be used on
studio website, publication and exhibitions.
For photos of my child/children
Yes, I give permission___
No, I deny permission___ to be used on
studio website, publication and exhibitions
4. During Classes
I understand for the safety, I will enter the studio to pick up my child(ren), and give the
studio special notice if someone else will pick up my child (ren) when camp is over.
Signature of Student's Parent/Legal Guardian
________________________
Print Name_____________________________
Date _______________________