Kids Clay with Jennie Sniderman (240504)Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Student InformationName *FirstMiddleLastPronounoptionalher/himshe/hethem/theyDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of SchoolMedical ConcernsParent/Guardian InformationName - Parent #1 *FirstLastEmail *Phone (primary) *Is this phone *MobileHomeWorkDo you want to add a secondary phone?YesPhone (secondary) *Is this phone (copy) *MobileHomeWorkAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you want to add a second Parent/GuardianYesParent/Guardian Information (second)Name - Parent #2 *FirstMiddleLastEmail *Phone (primary) *Is this phone *MobileHomeWorkDo you want to add a secondary phone?YesPhone (primary) *Is this phone *MobileHomeWorkAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact #1 (mandatory)Name *FirstMiddleLastPhone *Is this phone *MobileHomeWorkEmergency Contact #2NameFirstLastPhoneIs this phone (copy)MobileHomeWorkAuthorized Pickup ListPlease add any and all approved family or friends' names who may pick up your camper in this section. Name *FirstMiddleLastRelationship *Add another person?YesName #2 *FirstMiddleLastAdd another person?YesName #3 *FirstMiddleLastPoliciesPhoto Release Policy: By granting permission for registrant’s name, voice, photographic likeness, and student work to be used by Art Works Now, the following applies: For valuable consideration received, I grant to Art Works Now and its legal representatives and assignees, the irrevocable and unrestricted right to use and publish photographs or videos of the undersigned minor children, for editorial, trade, advertising, and any other purpose and in any manner and medium; and to alter and composite the same without restriction and without my inspection or approval. I hereby release Art Works Now and its legal representatives and assignees from all claims and liability relating to said photographs. I grant permission for the registrant's name, voice, photographic likeness, and student work to be used by Art Works Now. *YesNoHealth Policy: Stay home if you are sick, if you are positive for COVID-19, or if you are showing symptoms of COVID-19, a cold, or the flu. Anyone found to be positive for COVID-19, or who is actively exhibiting symptoms of COVID-19,, or flu while on AWN premises will be sent home immediately. While participating in an on-site program, participants shall notify Art Works Now immediately of a positive test result for COVID-19 via email to the Senior Director of Programs, Manique Buckmon at manique@artworksnow.org. Masks are optional. I acknowledge I have read and will comply with healthpolicy for attending in-person programming (mandatory) *YesCancellations, Refunds, Transfers, and Credits Policy: As a non-profit organization, AWN is committed to ensuring access to art high-quality arts education and experiences for all. To achieve this, we are committed to maintaining affordable tuition rates and are unable to provide refunds for registrations at this time. However, we do accept requests for transfers or credit in the event that registrants are unable to complete a class. All requests must be emailed to info@artworksnow.org. Please note, transfers are subject to availability and are not guaranteed. In addition, no transfers or credits will be provided for requests received less than two weeks prior to the first class session. If you have questions, please contact us by phone at 301-454-0808 or email at info@artworksnow.org. I acknowledge I have read the cancellations, refunds, transfers and credits policy (mandatory) *YesSignature *Please type your full name here as your signature.DateSubmit