Contact Us

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3711 Rhode Island Ave
Mt Rainier, MD, 20712
United States

301-454-0808

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Art Works Now Hyattsville Art Club

Hyattsville Art Club

Where:

Hyattsville Elementary

When:

All school year long starting August 23rd from dismissal to 6:00pm

What:

Art, snacks, play time, and homework time will be provided.

How much:

$125 a week per child. Payment will open shortly and an e-mail will be sent out to all interested families.

To reserve your spot:

  1. Click here to print out Health forms to be signed by Doctor or Physician.
  2. Click here to print out Financial forms. 
  3. Please turn in the Health and Financial forms in person by September 5th. 
  4. Pay the deposit below.
  5. Fill out the form below.
  6. Click here to read our Art Club Parent Handbook. Please bookmark or print out this document, it answers many frequently asked questions!
Hyattsville Art Club Deposit
125.00

In order to reserve your spot in the Hyattsville After School Art Club please pay the $125.00 deposit. If you have any questions or concerns please call 301-454-0808. 

Quantity:
Add To Cart

Please fill out the form below.

Child's Name *
Child's Name
Date of Birth*
Date of Birth*
Gender
Parent/Guardian Informationon
Parent/Guardian 1 Name: *
Parent/Guardian 1 Name:
Address *
Address
Parent/Guardian 2 Name:
Parent/Guardian 2 Name:
Address
Address
Emergency Contact
We need an additional non-parent emergency contact. We will alway contact both Parents/Guardians first.
Emergency Contact Name *
Emergency Contact Name
Please list a non-parent emergency contact
Art Works Now Permissions
Photography/Videography Consent *
I give consent to having my child photographed or filmed for promotional materials without their name being printed.
Health Information
Information and Instructions for Parents/Guardians REQUIRED INFORMATION The following information is required prior to a child attending a Maryland State Department of Education licensed, registered or approved child care or nursery school: • A physical examination by a physician or certified nurse practitioner completed no more than twelve months prior to attending child care. A Physical Examination form designated by the Maryland State Department of Education and the Department of Health and Mental Hygiene shall be used to meet this requirement (See COMAR 13A.15.03.02, 13A.16.03.02 and 13A.17.03.02). •Evidence of immunizations. A Maryland Immunization Certification form for newly enrolling children may be obtained from the local health department or from school personnel. The immunization certification form (DHMH 896) or a printed or a computer generated immunization record form and the required immunizations must be completed before a child may attend. This form can be found at: http://ideha.dhmh.maryland.gov/IMMUN/pdf/896_form.pdf •Evidence of Blood-Lead Testing for children living in designated at risk areas. The blood-lead testing certificate (DHMH 4620) (or another written document signed by a Health Care Practitioner) shall be used to meet this requirement. This form can be found at: http://apps.fcps.org/dept/health/MarylandDHMHBloodLeadTestingCertificateDHMH4620.pdf EXEMPTIONS Exemptions from a physical examination, immunizations and Blood-Lead testing are permitted if the family has an objection based on their religious beliefs and practices. The Blood-Lead certificate must be signed by a Health Care Practitioner stating a questionnaire was done. Children may also be exempted from immunization requirements if a physician, nurse practitioner or health department official certifies that there is a medical reason for the child not to receive a vaccine. The health information on this form will be available only to those health and child care provider or child care personnel who have a legitimate care responsibility for your child. INSTRUCTIONS Please complete Part I of this Physical Examination form. Part II must be completed by a physician or nurse practitioner, or a copy of your child's physical examination must be attached to this form. If your child requires medication to be administered during child care hours, you must have the physician complete a Medication Authorization Form (OCC 1216) for each medication. The Medication Authorization Form can be obtained at http://www.marylandpublicschools.org/NR/rdonlyres/B0050A99-6B3C-4396-A996- CC9405971A42/30754/1216_MedAuth_r120511.pdf If you do not have access to a physician or nurse practitioner or if your child requires an individualized health care plan, contact your local Health Department.
Address
Address
Date of last Physical *
Date of last Physical
Exact date preferred, but estimated date accepted.
Address
Address
Assessment of Child's Health
To the best of your knowledge has your child had any problem with the following? Check Yes or No. If you check Yes please explain at the bottom.
Allergies (Food, Insects, Drugs, Latex, etc.) *
Allergies (Seasonal) *
Asthma or Breathing *
Behavioral or Emotional *
Bladder *
Bleeding *
Bowels *
Cerebral Palsy *
Coughing *
Developmental Delay *
Diabetes *
Ears or Deafness *
Eyes or Vison *
Head Injury *
Heart *
Hospitalization *
If you select yes please explain below WHEN and WHERE at the bottom of the list.
Lead Poisoning/Exposure *
Life Threatening Allergic Reations *
Limits on Physical Activity  *
Sickle Cell Disease *
Speech/Language  *
Surgery *
If you answered yes to any of the above questions please explain in the space below.
Does your child take medication (Prescription or Non-Prescription) at any time? *
Does your child receive any special treatments? *
nebulizer, epi-pen, (etc.)
Does you child require any special procedures *
(catheterization, G-Tube, etc.)
Immunization Information
The following Information is required for program participants: All Participants must be current on all immunizations, see www.EDCP.org
Date of last Tetanus or DTP shot *
Date of last Tetanus or DTP shot
Exact date preferred, but estimated date accepted.
Is your child currently enrolled in in a Maryland school (public or private) *
If your child is not enrolled in a public or private school provide a copy of immunizations confirming that the child has received all immunizations as required by the Maryland DHMH Recommended Childhood Immunization Schedule. See www.EDCP.org (Immunization) for information.
Is the camper exempt from any immunization on medical or religious grounds? *
If yes provide a signed copy of Maryland Department of Health and Mental Hygiene Immunization Certificate from either a licensed physician indicating that the immunization is medically contraindicated, or the parent or guardian indicating that they object to immunizations for religious reasons.

E-mail info@artworksnow.org with questions.