Workshop Registration

Hands-on Family Workshop: Look Again! Art That Changes (October 19, 2024, 2:00 - 3:30 pm)

**Please wait until you receive confirmation about the status of your registration. Filling out this form does not guarantee a spot.**

Hands-on Family Workshop: Look Again! Art That Changes (October 19, 2024)

PARTICIPANT INFORMATION

Full Name(Required)

Nickname

Gender Pronouns

Grade(Required)

Will a parent or guardian stay for the whole program? If no, please complete the EMERGENCY CONTACTS section below.(Required)

Yes

EMERGENCY CONTACTS

Parent/Guardian Name (main point of contact)

Parent/Guardian Relation to Participant

Phone # where Parent/Guardian can be reached during the program:

Parent/Guardian Email

Additional Emergency Contact Name

Phone # where Emergency Contact can be reached during the program

ADDITIONAL INFORMATION + CONSENT

Is there anything that might be helpful for us to know about your child (medical, behavioral, other needs, etc.)?

Media Release(Required)

Yes

I hereby give permission to the Addison Gallery of American Art to use my child's name and photographic likeness in editorial and/or promotional material produced and/or published by the Addison in any form of printed or digital media. I waive any right to inspect or approve the finished product in which my or my child appears, or any copy that may be used in connection with it, now or in the future. I waive any right to royalties or other compensation arising from, or related to, the use of any photographic likeness.

Workshop Registration

Hands-on Family Workshop: Look Again! Art That Changes (October 19, 2024, 2:00 - 3:30 pm)