Please write in classes by letter & title:

Class Selection(s):______________________________________________________

______________________________________________________________________________________

Amount(s): __________________________________________________ Total: ____________________

Student's name: ________________________________________________________________________

Date of birth: _______________________________ Age ___________ Grade _____________________

Address: ______________________________________________________________________________

City__________________________________________ State _______ Zip: _______________________

Phone#:________________________________ Cell phone:_____________________________________

E-mail:________________________________________________________________________________

Parent/guardian names: ________________________________________________________________

School child attends: ____________________________________________________________________

Emergency contact: ____________________________ Emergency phone #:______________________

Allergies/Medical Problems/Concerns?____________________________________________________________________

Do you have a 2nd choice if class is full
or a preferable day if a class is added?______________________________________________________

If you took a discount who did you refer this session?_________________________________________

REQUIRED FOR REGISTRATION: Please Read Below and Sign

In consideration for the acceptance of my application for participation in ArtHouse Kids classes, I hereby waive, release and discharge Marylea Adams, Julie Stover and any member of their staff or families from and against any liability for any loss, personal injury, including death and property damage that may have arisen out of or in any way connected with my (my child’s) participation in the aforementioned activity. Furthermore I assume all responsibility and agree to indemnify Julie Stover, Marylea Adams and Art House Kids and staff for any loss, damage or injury to myself (my child) which may have been caused by negligence, or any act, of any person connected in any way with the aforementioned event. I have read the above and understand its meaning and voluntarily sign it.

______________________________________Signature of Parent/Guardian

MAKE CHECK PAYABLE TO ARTHOUSE & MAIL TO:
THE ARTHOUSE 1043 LINCOLN AVENUE, SAN JOSE CA, 95125

______________________________________________________________________________________

Please Note!

• ArtHouse can only hold a spot in a class with paid registration.
• You can deduct $15 from your tuition for signing up a sibling, referring a new student who joins this session, or signing up for more than one summer art camp; this discount is only applicable on classes over $100. Only one referral discount is allowed per session.
• In the event that we fill a class we will start a waiting list for that class and possibly add a new class.
• We apologize but classes with enrollment of fewer than six children may be subject to cancellation.
• ArtHouse provides one make-up class at the end of the session and we do not give refunds or credits for classes if children are absent for any reason.
• If you decide to withdraw your child from class before the session starts we will refund your full tuition.
• Please dress your child in art appropriate clothing; some materials we use are not washable!
• Please drop off and pick up your child on time as we teach several classes back to back.
• ArtHouse provides scholarships students in need of financial assistance.
• Questions? arthousekids@yahoo.com or (408) 975-9987.