2013 ArtWorks Connellsville Summer Workshops
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Transcript of 2013 ArtWorks Connellsville Summer Workshops
Fayette County Cultural Trust/ArtWorks Connellsville
Summer Art Workshops 2013 Registration
Please return this form to:
ArtWorks Connellsville 139 West Crawford Avenue, Connellsville, PA 15425
724-320-6392 www.artworksconnellsville.org
Due to space and optimum instructor to student ratio the number of students registered in the
program is limited to 12 participants per class.
Classes will be held at 139 West Crawford Avenue Connellsville, PA 15425- 724-320-6392 One form per student. Please Print.
Student’s Name:_________________________________________________________
Address:_______________________________________________________________
City:____________________________ State:_____ Zip:______________
E-mail address:__________________________________________________________
Daytime Telephone Number: ___________________________________
Alternate Telephone Number: ___________________________________
School attending:_____________________________________________
Grade:____________ Student’s age:_____________ Gender:__________
Parent or Guardian’s Name:_____________________________________
(___) Check here if information is same as above.
Address:______________________________________________________
City:____________________________ State:_____ Zip:______________
E-mail address:________________________________________________
Daytime Telephone Number: ___________________________________
Alternate Telephone Number: ___________________________________
Emergency Contact Name:_____________________________________
Emergency Contact Telephone:_________________________________
Fayette County Cultural Trust/ArtWorks
Connellsville
2013 Summer Art Workshops
Summer Art Camp Policies
Photographs
We periodically take photos of students working in class or with their finished products. These photos
may be used on our websites (www.fayettetrust.org & www.artworksconnellsville.org). If you do not want
photos included on the website, please let us know at the start of class. Only first names will be used with the
photos.
Expected Behavior
All participants are expected to behave in an appropriate manner while in the class. We will work
with each child to make sure that he/she understands the rules and expectations. We reserve the
right to ask any child to stop attending classes if they have shown an unwillingness to follow the rules.
Child and Project Pick-up
We reserve the right charge an additional fee to keep your children past their class period. Please be
prompt! Finished projects will be kept for two weeks after you are given notice that they are ready
for pick up.
Hold Harmless Agreement
I hereby release, hold harmless, defend and indemnify Fayette County Cultural Trust, Summer Art Camp, their
affiliates, officers, members, agents, employees, and other participants from any and all damages, injuries,
claims and causes of action which may accrue to or be asserted by me or any minor child of mine arising
directly or indirectly out of my minor child’s participation in art classes/activities at Summer Art Camp. I also
give my permission to the aforementioned organization for the free use of my likeness and that of my child or
ward, in connection with any broadcast, telecast, print media or other publicity. The undersigned hereby
forever releases, discharges and covenants to hold harmless Fayette County Cultural Trust and teachers from
any and all claims, demands, damages, costs, expenses, loss or services, actions and causes of action belonging
to the undersigned or arising out of any act or occurrence in connection with and particularly on account of all
personal injury, disability, property damage, loss or damages of any kind sustained or that may hereafter be
sustained arising out of the matters described herein.
Permission to Provide Emergency Medical Treatment
I authorize Michael Edwards to organize any required medical or first aid procedure, or to take the
undersigned student to the hospital emergency room for treatment. I understand that every effort
will be made to notify me or individual indicated as emergency contact beforehand by telephone.
This Release and Hold Harmless Agreement shall constitute a full and complete release of any
and all claims for all classes taken on or after the undersigned date.
PARTICIPANT NAME___________________________________________________________
PARENT SIGNATURE_______________________________________DATE _______________