• CREATIVE ART STUDIOS

  • Participant's Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Sibling's Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant's Gender*
  • Sabling's Gender
  • Has Participant painted before?*
  • Has Sibling painted before?
  • Which Time Slot Would You Like To Attend?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Will Participant feel comfortable wearing an apron?*
  • Will Sibling feel comfortable wearing an apron?
  • Is Participant okay with using their hands in clay, painting with their fingers, etc. We will provide canvases, paint brushes and have paint available for each participant as well.*
  • Is Sibling okay with using their hands in clay, painting with their fingers, etc. We will provide canvases, paint brushes and have paint available for each participant as well.
  • Participant and Sibling's Medical Information

  • Does Participant need someone assigned to them at all times?*
  • Does Sibling need someone assigned to them at all times?
  • Any behavioral concerns we should be aware of for Participant?
  • Any behavioral concerns we should be aware of for Sibling?
  • Is Participant Verbal or Nonverbal*
  • Is Sibling Verbal or Nonverbal
  • Can Participant follow 1 step directions?*
  • Can Sibling follow 1 step directions?
  • Contact Information in Case of Emergency

  • Format: (000) 000-0000.
  • Photo Release Form - I hereby grant permission to Complete The Puzzle to use photographs and/or video of the participant participating in the art program, i.e. in publications, news releases, online, and in other communications related to the mission of Complete The Puzzle.*
  • LIABILITY WAIVER: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending this program and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the five week program may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Complete The Puzzle, the volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the event (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Complete The Puzzle, its volunteers, agents, and representatives, of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Complete The Puzzle, the volunteers, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any of our programs.

     

  • My Products*

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        Participant's Fee
        $20.00$20.00
          
        Sibling's Fee
        $10.00$10.00
          
        Total
        $0.00$0.00
      • Payment Methods

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