Artist / Student Name *

First Name

Last Name

Name of Parent/Caregiver (if applicable) *

First Name

Last Name

Phone *

(###)

###

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Emergency Contact Information *

In case of emergency, if caregiver cannot be contacted, please contact:

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Emergency Care *

In case of emergency, if deemed necessary by HHAS, I give permission to call an ambulance. Typing name will serve as signature.

First Name

Last Name

Aside from myself, my child may be picked up and walked home by:

First Name

Last Name

Phone

(###)

###

####

First Name

Last Name

Phone

(###)

###

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Photo Consent *

I agree to the photo consent policy outlined on the HHAS policies page

Yes

No

I agree to all Policies and Procedures *

Yes

Signature of Self or Caregiver *

Typing name will serve as signature By signing below I, the parent, caregiver or student, hereby acknowledge that (i) I have fully read and understood the Hudson Heights Art Studio (HHAS) Policies and Procedures and (ii) I have completed, read and understood the required HHAS Registration Agreement. I have made the owner aware of any allergies or any accommodation or consideration that me or my child may require. I have made the owner aware of any evaluation or diagnosis that may affect my child's performance or well being.

First Name

Last Name