Beacon's Buddies After School Art Club Registration

Register Your ARTIST!

CONTACT DETAILS

* Indicates required field

Parent/Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Local Contact Name *

First

Last

Local Contact Phone Number *

CAMPER DETAILS

Artist's First & Last Name *

First

Last

KID'S CLUB MEMBER *

YES NO

SEX *

SCHOOL *

Webber Road Elementary does have a school bus that drops off by our Clubhouse at 3591 Elliott Road. Check if your school has the option as well.

HAIR COLOUR *

EYE COLOUR *

Date of Birth *

Age *

GRADE *

PERSONS AUTHORIZED TO PICK UP THE ARTIST *

EMERGENCY INFORMATION

Name OF EMERGENCY CONTACT *

First

Last

EMERGENCY CONTACT Phone Number *

CARE CARD NUMBER *

DOCTOR'S NAME *

DOCTOR'S Phone Number *

MEDICAL CONCERNS *

TERMS & CONDITIONS

! give permission to consult a physician other than my family physician. I authorize Beacon's Family FUNdation Society Staff staff to have a physician attend to my child in the event of an emergency. Beacon's Family FUNdation Society will not be responsible for any medical costs.
To the best of my knowledge my child is in good health and has not been exposed to an infectious illness or disease within two weeks prior to attending after school art club. If my child is exposed to an illness or is sick on the day of the art club, I understand that Beacon's Family FUNdation Society must be notified and my child may not be permitted to attend the art club class.
I authorize Beacon's Family FUNdation Society to film and or photograph my child and acknowledge that all photographs become the property of Beacon's Family FUNdation Society marketing and promotional materials, including but not limited to website and programs. I understand the circulation of the materials could be used worldwide and there will be no compensation for this use.
I agree to assume all risks involved in my child in participating in Beacon's Family FUNdation Society After School Art Club. I agree to indemnify and save harmless Beacon's Family FUNdation Society, its servant and agents, relieving them of all liability for losses and damages of all and every description for the camp participant or myself may suffer or be put to.
To complete your registration, please complete and submit the registration form; payment deposit is due upon registration. Late cancellation or no shows will result in 100% of the fee non-refundable. Completed registration forms and cancellations must be emailed to [email protected].

BILLING INFORMATION

PAYMENT METHOD *

CREDIT CARD NUMBER *

EXPIRY DATE (MM/YY) *

PAYMENT PREFERENCES *

CSC *