Child's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

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Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

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Start Date *

Please choose the date your child will begin attending

MM

DD

YYYY

Be Advised *

Any and all fees paid are totally non-refundable and non-transferable in the event of absence of the child under any any all circumstances. Epipens must be worn at all times. No food is allowed in the studio Please send your children in comfortable clothing that may be stained.

I understand

Waiver *

I give permission for my child to participate in programs facilitated by the Children’s Art/Play Studio and Staff at the above listed location. I give permission for my child to be accompanied by the Children’s Art/Play Studio staff to the bathroom that is located in the building. I give permission for Children’s Art/Play Studio, staff, and Maria Wowk to take whatever steps are reasonably necessary to obtain emergency medical care if required. Any expenses incurred in carrying out these steps will be borne by the child’s family. Your child WILL NOT be permitted to be picked up by anyone else, other than a parent, without written consent as well as telephone confirmation from Children’s Art/Play Studio. Children’s Art/Play Studio/Maria Wowk is not responsible for anything that may happen as a result of false information given on this form. I, the undersigned agree, and do hereby irrevocably release Children’s Art/Play Studio/Maria Wowk, her heirs, and all associated persons from liability and all claim for damages regarding incident or injury sustained by my child in any program related activities. I grant permission for my child to participate in these activities and will not make claim against, or attack the property of Children’s Art/Play Studio in any respect.

I agree

Date

MM

DD

YYYY