Child's Name *

First Name

Last Name

Parent's Name *

First Name

Last Name

Parent's Phone Number *

(###)

###

####

Class Date *

MM

DD

YYYY

Photo Release *

I hereby grant permission to Artsey Art to use photographs and/or video of my child taken during workshops in publications, news releases, online, and in other communications related to the mission of Artsey Art.

Yes

No