Parent's Name

First Name

Last Name

Child's Name

First Name

Last Name

Child's Birthdate

YYYY

Art Class Selection

Does your child have a sibling or friend they would like to be with? If yes, please list.

What size t-shirt does your child wear?

Are you a member of AMoA?

Yes

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Instructions

Name/phone number of person(s) picking up if different from above:

Each child must be picked up at the classroom inside the building. Please try to be on time when picking up children.

Emergency phone numbers/contacts:

Does your child have any food allergies?

LIABILITY

I certify that my child listed above has my permission to participate in the Amarillo Museum of Art's Museum School program. I authorize the Museum Staff to act for me according to their best judgement in an emergency requiring medical attention. I hearby waive and release the Amarillo Museum of Art and its staff of liability for injury. I know of no mental or physical problem which may affect my child's ability to safely participate in art classes.

Yes

PHOTOGRAPH/VIDEO RELEASE

I give the Amarillo Museum of Art permission to take photographs or video images of my child working in the Museum School classroom or viewing the artwork on exhibit in the galleries/sculpture garden. I also give permission to use reproductions of my child's artwork. These images may be used for, but not be limited to the following: AMoA brochures and other marketing materials such as upcoming class schedules, television commercials, newspaper articles, AMoA social media platforms and the AMoA website.

Yes

PARENT AUTHORIZATION

By checking this box, I agree that I am the legal guardian of this child and that the above information is correct.

Yes

No, Additional paperwork will be required on the first day of class