Mrs. B’s Petite Galerie
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  Mrs. B's Petite Galerie
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  • Registration Forms

    SUMMER CAMP REGISTRATION FORM

    To insure a spot in your preferred camp(s), please complete and return this form with a $20 nonrefundable deposit by June 15, 2015 to Cheryl Bielli c/o Mrs. B’s Petite Galerie. Call 725-6130 for mailing address.  

    Day campers will be admitted as space permits. Please call 725-6130 at least two days ahead to check for availability. 

Submit

    ELECTRONIC AND PRINT MEDIA RELEASE FORM

    I give my permission for Cheryl Bielli (or an agent of Cheryl Bielli) of “Mrs. B’s Petite Galerie & Studio” to use the image and/or name of the student listed below to promote her art business and/or art portfolio to demonstrate some of the art projects students do in her classes.

    I understand that the image and identification might appear in photographs made public on the Internet or in printed materials disseminated to the public.

    I also understand that in some cases such accessibility to the public has resulted in deviant behavior toward people appearing in photos.

    I may revoke my permission at any time by notifying Cheryl Bielli IN WRITING that I no longer want my image/the student’s image to appear in electronic or print media promoting Mrs. B’s Petite Galerie & Studio. Until that time, my signature above indicates that the image and identity may be used for such purposes.

Submit

    Emergency Contact Form

    Please complete the following form regarding emergency contact information and permission to seek emergency medical treatment. By completing this form, I signify that I grant Cheryl Bielli or an agent of Cheryl Bielli to seek emergency medical treatment for the below named student(s) if I cannot be reached. Thank you.

Submit

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