KidsArt Information Form If you are human, leave this field blank.KidsArt Information Form This form provides the information we need for your student/s to attend KidsArt Classes. It does not register them in a class.Student Information Student 1 First Name *Student 1 First Name *Student 1 Last Name *Student 1 Last Name *Student 1 Age *As of May 31, 2025Student 2 First NameStudent 2 Last NameStudent 2 AgeAs of May 31, 2025Student 3 First NameStudent 3 Last NameStudent 3 Last NameStudent 3 AgeAs of May 31, 2025Parent/Guardian Name *Address *CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codePhone *Work PhoneEmail *Emergency Contact, Release Form and Pick-up Authorization 1st Parent/Guardian Name *Phone *2nd Parent/Guardian NamePhoneOtherPhoneNot AuthorizedDoctor's Name, Preferred Hospital Doctor's NameDoctor's PhonePreferred HospitalAllergies, Medical Conditions Student 1 AllergiesStudent 2 AllergiesStudent 3 AllergiesPolicies: Please Read and Agree *I have read and agree to these policies• Children must be age 6 & have attended kindergarten to register for Marvelous Mondays, Talented Tuesdays, and KidsArt. • Staff & instructors at Herrig Center for the Arts will not be responsible for administering over-the-counter or prescription drugs to students. • In fairness to all, disruptive behavior will not be tolerated during camp for any reason. We reserve the right to ask a parent/guardian to remove their child from the Herrig Center for the Arts without benefit of a refund or monies paid for any/all camp sessions. • Drop off of your child is no earlier than 8:45am. If enrolled in aftercare, pick up time is no later than 5:00pm. • Personal items such as music devices, cell phones, etc. are not permitted in class. Photo Release *YesNoI hereby give permission for images of my child captured during KidsArt Camp or After School Programs through video, photo or digital camera, to be used solely for the purpose of promoting Herrig Center for the Arts programs. I waive any rights of compensation or ownership thereto.Liability The signature below of an authorized parent or guardian of the registered child/children acknowledges and accepts the conditions of payment and Herrig Center for the Arts Policies as stated above, in the brochure, catalog and online. We also authorize Herrig Center for the Arts staff to contact, consult and authorize emergency treatment, if required, with the above named physician, or other professional medical personnel such as EMS services, in the case of inability to reach any of the above named Parent/s or Guardian/s or other Emergency contacts.Parent/Guardian Signature *Please enter your first and last name.Date *Submit
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