Kelowna Art Gallery – Children’s Art Class Registration Form  

Class: ____________________________________ Date:________________________________

Student’s Name: ______________________________Age______________________________ 

Address: __________________________________ City : _______________________________

Postal Code: ___________________              Home Phone: _______________________________

PLEASE NOTIFY US OF ANY HELPFUL INFORMATION PERTAINING TO YOUR CHILD: (For example: Allergies including drug and food, learning disabilities, special needs, etc.) This confidential information is give only to instructors in order to make our class as safe and positive as possible for your child.

If so, please fill out the additional medical form for your child

Brief Questionnaire

1.      Is the student returning?______________________________

2.      Do we have your permission to take photographs of the student during classroom activities?___________________________________

3. Would you like to be on our email list for upcoming children’s classes? Yes            No
         Email address___________________________________________________

 I authorize the Kelowna Art Gallery staff to take the student off site for scheduled activities.

 I will pick up the student ___________________from the Art Adventures program. In my absence, I hereby authorize either of the following two people to pick up the student: 1._______________________________ 2._______________________

These people may be required to provide identification to the Art Adventures staff to verify their name 

Students, who cancel their registration, transfer classes or request a credit, must do so no later than seven days prior to the first class. A $15.00 cancellation fee will apply. After this time, no refunds are available unless for medical reasons. Requests for medical purposes must be made in writing with a doctor’s note. There will be a $15.00 service charge on N.S.F cheques.

I on behalf of the student and the student’s parents and guardians hereby release the Kelowna Art Gallery Association, its Directors, Officers and Employees, Volunteers and the City of Kelowna  and its officers and employees from all actions, claims and demands for damages, loss or injury arising from any accidents which may be caused by, or arise out of the participation of the student named in any program or in any facility or at any location where a program is being held, whether or not caused by the negligence of or any of the aforesaid persons.

Signature of Parent / Guardian: _________________________________________________

Witness:______________________________ Print name:_____________________________

Please make cheque payable to Kelowna Art Gallery .

Membership: _______________________                        Staff Initial____________________

Payment: ___________________________