Summer Workshops 2019 Registration Form:

                 

Student(s) Name(s):_______________________________________     Age(s):____

 

Address:______________________________________________________________________

 

            ______________________________________________________________________

 

Home Phone: _________________________________________ 

 

Cell Phone: __________________________________________

 

Email:________________________________________________________________________

 

 

Emergency Contact : (Name and Phone number)

 

___________________________________________________________________________

 

Indicate ( 1 ) Session Choice Below:  

 

SESSION I  

 

    Monday-Friday,    July 15-19            11-2 PM                  $325         _______

     

 

SESSION II 

 

    Monday-Friday,     July 22-26             11-2 PM                 $325         _______

 

 

 

Note:  Another session and may be added as my family's summer schedule allows.  

 

 

 

       I/We the undersigned, parents of, ______________________, a minor, do hereby release and hold harmless Young at Art and Nancy and Mark Altemus (hereinafter “owner”) from any claims for  personal  injury or other damage arising from my/our child’s attendance and participation in the program located at 4112 Dresden Street, Kensington, MD 20895.                                                                                           

 

 

 

___ Please check here if you DO NOT GIVE PERMISSION for your child's photograph or art work to be on our website.

 

 

Parent Signature:____________________________________________________Date:___________

       

 

                                    Please print out form and mail with payment to: 

                                                          Nancy Myers Altemus/YOUNG at ART

                                              

                                            4112 Dresden Street, Kensington, MD 20895

                                                     VENMO PAYMENTS ALSO ACCEPTED.

                                             

 

 

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