Summer Workshops 2019 Registration Form:
Student(s) Name(s):_______________________________________ Age(s):____
Home Phone: _________________________________________
Cell Phone: __________________________________________
Emergency Contact : (Name and Phone number)
Indicate ( 1 ) Session Choice Below:
Monday-Friday, July 15-19 11-2 PM $325 _______
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.
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.