Parents’ Night Out February

Student #1 Information

Name Student #1

First

Middle

Last

Pronoun

Date of Birth

Name of School

Add 2nd Student?

Yes

Student #2 Information

Name Student #2

First

Middle

Last

Pronoun

Date of Birth

Name of School

Add 3rd Student?

Yes

Student #3 Information

Name Student #3

First

Middle

Last

Pronoun

Date of Birth

Name of School

Medical Concerns

Parent/Guardian Information

Name

First

Last

Email

Phone (primary)

Is this phone:

Mobile
Home
Work

Do you want to add a secondary phone?

Yes

Phone (secondary)

Is this phone:

Mobile
Home
Work

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you want to add a second Parent/Guardian

Yes

Parent/Guardian Information (second)

Name

First

Middle

Last

Email

Phone (primary)

Is this phone:

Mobile
Home
Work

Do you want to add a secondary phone?

Yes

Phone (primary)

Is this phone:

Mobile
Home
Work

Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact #1 (mandatory)

Name

First

Middle

Last

Phone

Is this phone:

Mobile
Home
Work

Emergency Contact #2

Name

First

Last

Phone

Is this phone:

Mobile
Home
Work

Authorized Pickup List

Please add any and all approved family or friends' names who may pick up your camper in this section.

Name

First

Middle

Last

Relationship

Add another person?

Yes

Name #2

First

Middle

Last

Add another person?

Yes

Name #3

First

Middle

Last

Policies

Photo 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.

Yes
No

Health 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)

Yes

Cancellations, 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)