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.
My child(ren) will attend Mrs. B’s summer art camp(s) on the following dates:
*
June 29 - July 2
July 20 - 23
August 10 - 13
Number of Children attending for each date checked above
*
Children's Names and Ages
*
Phone Number
*
Email
*
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.
Student Name
*
First
Last
Date
*
Phone Number
*
Email
*
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.
Camps or Classes
*
Child/Children's Names
*
Parent's Name(s)
*
Email
*
Additional Information: Please enter address, phone number, cell phone number for parents and an emergency contact as well as any allergies or health concerns.
*
Submit
