New Art Student Intake Form

Please fill out the form if your child is attending Private Art Classes for the first time or if you would like to provide updated information for a previously submitted form.

This form must be filled out and submitted by the parent/legal guardian of the minor child who will be attending.

Child's Full Name

First Name

Last Name

Child's DOB

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Legal Guardian

First Name

Last Name

Relationship to the child

Cell Phone

(###)

###

####

Email

Parent/Legal Guardian 2

First Name

Last Name

Cell Phone

(###)

###

####

Relationship to the child

Emergency Contact

Person other than parent/legal guardian

First Name

Last Name

Cell Phone

(###)

###

####

Relationship to the child

Is your child interested in Weekly or Bi-weekly Classes?

Select one

Weekly

Bi-weekly

Please select the Day and Time your child will be attending classes

This will be a reoccurring class

ALLERGIES & MEDICAL CONDITIONS

Please list any allergies, medical conditions, special needs, or disabilities that Yesi Makes Art should be aware of. If none apply, please write N/A.

PHOTO AND VIDEO CONSENT

I hereby give my consent to Yesi Makes Art to take and use photographs and videos of my child for any legal use including but not limited to advertising and publicity purposes, as follows: printed publications or materials, posters, brochures, electronic publications, and social media. I hereby waive, release, and forever discharge Yesi Makes Art from any and all claims or liability arising from the use of my child’s photograph or video for the above purposes. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Furthermore, I understand that no royalty, fee, nor other compensation shall become payable to me by reason of such use.

Yes, I give permission to Yesi Makes Art to take and use my child's picture and video for the purposes listed above.

No, I do not give permission to Yesi Makes Art to take and use my child's picture and video.

Please Print Your Name

This will serve as your signature

First Name

Last Name

Today's Date

MM

DD

YYYY