KidsArt Information Form by acm_admin 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 Last Name: *Last NameStudent 1 Age: *As of May 31, 2026Student 1 AllergiesStudent 2 First Name:Student 2 Last Name:Student 2 Age:As of May 31, 2026Student 2 AllergiesStudent 3 First Name:Student 3 Last Name:Student 3 Age:As of May 31, 2026Student 3 AllergiesParent/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 2nd Parent or Guardian Name *Phone *Other Authorized AdultsPhoneOther Authorized AdultsPhoneNot Authorized:Doctor's Name, Preferred Hospital Doctor's NameDoctor's PhonePreferred HospitalPolicies: Please Read and Agree *I have read and agree to these policiesHerrig Center for the Arts reserves the right to cancel a class due to insufficient enrollment. Students will be contacted and given the option of a full refund or a credit for another class. Cancellation or transfers prior to one week before the first class results in no refund or credit. Cancellation within one week of the first class of the session or after the class has begun results in no refund. Registering for a class is a commitment to attend all the classes in a session. If a student is unable to attend one or more classes in a session there will be no reduction in the cost of that session. There are no refunds, transfers or credits once a class has begun.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 type first and last nameDate *SubmitTextreCAPTCHA is required.
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