Spring Break 2019 Student Registration

List the child enrolling in Newspring's Spring Break Art Camp

Please complete this section for the child listed above.

Please complete the information for the parent/guardian.

Please provide contact information for an emergency contact other than the parent/guardian listed above.

Children will only be released to a parent or a person designated by the parent/guardian after verification of ID. I hereby authorize the program to allow my child to leave ONLY with the following persons. Please list name and telephone number for each.

I hereby give consent for my child(ren) to be transported and supervised for emergency medical care. In the event I cannot be reached to make arrangements for emergency medical care, I authorize the program to transport my child to:

For each section below, check the box(es) indicating whether or not you give your consent.

We will visit The Museum of Fine Arts Houston on March 15th to see the Van Gogh Exhibition.

If possible, could you be specific? For example- if it was word-of-mouth- who did you hear it from?...was the program recommended to you by a teacher? ...did you receive Newspring's Program Flyer through an email?...did you learn about Newspring through Social Media? Thanks!

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