Stanley Picker Gallery: SATURDAY ART CLUB
Please complete and return this form to the Education Coordinator, Natalie Kay at n.kay@Kingston.ac.uk or using the
contact details given, before booking onto any Saturday Art Club sessions Thank-you and we look forward to welcoming
you to Art Club!
Where did you hear about us?
REGISTRATION
Child’s Name
d.o.b
Child’s Name
d.o.b
Child’s Name
d.o.b
Child’s Name
d.o.b
Parent/Guardian
Relationship to child
Address
Emergency Contact Number
Email (used for gallery communications only)
School
Year/Class group
Other adults who may collect child
Relationship to child
Relationship to child
Relationship to child
NEW ART CLUB MEMBER – tell us about you!
What are your likes and interests?
What is your favourite way of making art?
What are you looking forward to about Art Club?
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Stanley Picker Gallery: SATURDAY ART CLUB
HEALTH & SAFETY (confidential)
Does your child/children have allergies (inc. food) or illnesses that the SPG should be informed of?
If yes, please explain nature of condition and how it can be identified and treated
Y/N
PHOTO RELEASE
Please circle a reply to each statement below.
I give consent for photographs or video footage of the young person named below to be used by the Stanley Picker
Gallery and artist facilitators leading sessions:
documentation of creative learning
Y/N
display in public places
Y/N
reports and publications to be published about exhibitions
Y/N
on websites accredited by above parties
Y/N
PLEASE COMPLETE & SIGN
Child’s Name
Parent/ Guardian
Signature
Date
NB. The above photo release form is valid for four years from the date of signing. The Stanley Picker Gallery will seek
renewed consent if the photograph(s) are to be re-used after that time.
Please email this completed form to the Education Coordinator, Natalie Kay at n.kay@Kingston.ac.uk or post to the
address below.
Stanley Picker Gallery, Faculty of Art Design & Architecture, Kingston University, Knights Park, Kingston, KT1 2QJ
020 8417 4074 www.stanleypickergallery.org
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