Program Registration

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To complete a registration, participants must pay for the class through our event calendar, and then fill out the registration information form below (for participants under 16) to ensure we have the health and safety information for the participant on file.

Program Registration Form

Program & Participant Information
Name of Program
Program Date
Student 1
First Last
Age
Student 2
First Last
Age
Student 3
First Last
Age
Parent/Guardian's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Authorized Pickup Information (Participants Under 12)
This information must be filled out before any student under the age of 12 is allowed to participate in classes at Latcham Art Centre, unless accompanied by a parent/guardian. The information on this form will be kept confidential and is intended only to ensure safety. Please fill out names as they appear on the individual's ID.
Authorized Pickup Name 1
First Last
Phone
Authorized Pickup Name 2
First Last
Phone
Authorized Pickup Name 3
First Last
Phone
Health & Medical Information (Participants Under 16)
This information must be filled out before any student under the age of 16 is allowed to participate in classes at Latcham Art Centre. The information on this form will be kept confidential and is intended only to ensure safety.
Emergency Contact Name
First Last
Phone
Allergies / Medication
Special Needs/Behavioral Considerations
We want to give your child the best experience possible. Please let us know of any physical, emotional or behavioral considerations they may have so that we can be better prepared to do this.
PHOTO & VIDEO PERMISSION
- YES, I CONSENT TO HAVING PHOTOGRAPHS & VIDEO OF MY CHILD TAKEN.
- NO, I DO NOT CONSENT TO HAVING PHOTOGRAPHS & VIDEO OF MY CHILD TAKEN.
Latcham Art Centre would like permission to use any photographs and videos taken in the program in future promotional material. By checking yes you grant us permission to use possible photographs and videos of your child in public print and/or online public material.
How did you hear about us?
- school flyer
- email
- newspaper
- online
- other
As a participant in one of Latcham Art Centre’s programs, you will receive occasional mailings and reminders about programs and events. We do not sell or trade our mailing list.
- YES, I CONSENT TO RECEIVING EMAILS
- NO, I DO NOT WISH TO RECEIVE EMAILS
Date
MM slash DD slash YYYY
Signature

Program Registration

Program Registration Form

Program & Participant Information

Authorized Pickup Information (Participants Under 12)

Health & Medical Information (Participants Under 16)