Class Registration Form

Brush and Palette Art Gallery Art Class Registration
STUDENT INFORMATION
Name/s ______________________________________________
Address ______________________________________________
City _______________________State_______Zip ________

Phone _________________ Work Phone (opt.) _____________

(Under 18) Age ___ Grade ____ Date of Birth ____________
Parent/Guardian  _____________________________________
Who is authorized to pick up student _______________________

Please inform us of any special needs a student has_____________

Emergency #_______________ Relationship to child ____________
Please provide your email to receive the next class brochure, or go to bpartgallery.blogspot.com and click on class schedules in the gray box. Your email is confidential and will not be sold or shared.
Email Address ________________________________________

CLASS INFORMATION
Class Name /Instructor Name         Class Fee            Supply Fee
_______________________$ __________$ _____________
_______________________$ __________$ _____________
_______________________$ __________$ _____________
                                                                  Total Fees $____________

Please make class checks payable to to the individual instructor (Payment is due at the time of registration). Enrollment is on a first-paid basis.

RELEASE OF CLAIM FOR PERSONAL INJURY AND PROPERTY DAMAGE
The undersigned agree that the Brush and Palette Art Gallery or any of its agents, agencies, boards or staff, shall be released from liability, claims, or demands whatsoever in the event of any accident or injury to said participant resulting directly or indirectly from their participation in a program or activity at the Brush and Palette Art Gallery.

PHOTOGRAPH PERMISSION
I give permission for the Brush and Palette Art Gallery to use, without obligation, photographs which may include my image or artwork for purposes of promoting future programs.
Yes ________ No ________  Yes but not _______________________________________

REFUND POLICY
Classes with insufficient enrollment will be cancelled & all fees returned. No refunds will be granted after the first class, or if a student misses any classes. Classes cancelled 7 working days prior to the first published meeting of the class will receive a full refund of class and supply fees.
________________________________________________________________________
Signature of Student (or Parent / Guardian)

1. Supplies and equipment for children’s classes provided by instructor.
2. Children classes are limited to 6 students.
3. Art projects are usually messy – so be sure to dress your child accordingly.
4. Any beverages brought to class should be in a container with a lid.
5. Please be prompt. If you can’t attend, please tell the instructor. (see contacts page for phone #s)