Art Camp Registration Form | Museum of East Texas

Registration Form

Individual registration is required for each participant. Please fill out this form completely before registering for individual classes. Viewing may be easier on desktop screens.

Participant's First Name

Last name

Participant Date of Birth

M/F

Parent/Guardian 1

Parent/Guardian 2

Phone 1

Phone 2

Street Address

City

Region/State/Province

Postal / Zip code

This address will be used to mail an invitation to the Art Camp Exhibition Closing Reception. Two additional addresses may be submitted on the Exhibition section further below.

Student Health Form

In order to protect the health of all, Museum of East Texas prohibits students from attending class when ill with a communicable disease or condition such as chicken pox, the flu, head lice, pink eye, or strep throat.

Museum of East Texas reserves the right to notify parents/guardians regarding any student wo becomes ill during class and to request that said student be picked up immediately. The Museum of East Texas also reserves the right to request Physician's authorization to return to class.

Parents/guardians are welcome to visit on site to administer medications at any time. The Museum of East Texas encourages you to consult with your child's physician to accommodate the class schedule. The Museum of East Texas will not accept medications without a prescription or medications that have expired.

For students with food allergies, please note that our faculty and staff do not monitor what other children bring on site for snacks and cannot guarantee a nut-free environment.

Emergency Contacts

Emergency Contact 1 (other than guardians listed above)

Phone 1

Emergency Contact 2

Phone 2

Health History

If other, specify here:

Does student have an epipen?

Please describe what the student is allergic to and known reactions:

Please indicate desired action to be taken and any medication to be administered in case of mild or severe allergic reactions:

Does the student have asthma?

Yes

Does the student require an emergency inhaler?

Yes

Does the student have special needs?

Yes

Immunizations including DPT or Tetanus as of date

*If you have answered that the student has allergies, asthma, or special needs, please see the Executive Director and/or the Directors of Education at the Museum of East Texas.

Health Agreement

This health history is correct and accurately reflects the health status of the student to whom it pertains. Student has permission to participate in all camp activities except as noted by me/or an examining physician. If I (or my subsequent emergency contacts) cannot be reached in an emergency I give permission to the Museum of East Texas and its agents to call 911. I understand the information on this form will be kept confidential and only shared with necessary personnel. I give permission to photocopy this form. I have read, understand, and agree to all Registration Guidelines and Policies. Registration will not be processed without signature.

Signature of Guardian

Select a date

Relationship to Student

Arrival/Departure Information

Enter at the main entrance on 2nd street, accessed from the plaza. Our special needs campers can enter from Paul Ave. Doors will not open until 15 minutes prior to your class and students must be picked up promptly after class. The safety of your child is very important to us, therefore, we require parents/guardians to walk their children in and out of the museum for drop-off and pickup. Camp participants may be picked up at the Museum ONLY by those designated below.

Pickup 1

Pickup 2

Pickup 3

Anyone who should NOT pick up your child?

Media Release

The Museum of East Texas takes photos of activities involving students to promote our events and programs. Some photographs may show you and your child's participation directly or indirectly. These photos may be published through our website, social media pages, newsletters, and brochures. Please provide your consent to photos being taken and published below.

Media Release agreement

I agree

I do not agree

Art Camp Exhibition

Art Campers, parents, and guests will be invited to a special reception to view their children's artwork on August 4th, 2024, from 2-4pm. Work displayed during the Art Camp exhibition will be collected during Art Camp and stored at the Museum until the Art Camp Reception Closing Exhibition, when it can be collected. The Museum will not be responsible for art left at the Museum after August 18th. Please indicate below if you would like your child's artwork to be displayed during the Art Camp Exhibition. If yes, we will send up to 3 invitations to the addresses filled out below.

Particiption in Exhibition:

No, we will not be participating; therefore, do not keep any of my child's artwork

Yes, please display my child's artwork during the Art Camp Exhibition

Name

Address

Name

Address

Name

Address

Waiver & Release of Liability

Although the Museum of East Texas hopes that no student is ever injured or hurt, injuries are a possibility of participation in Art Camp. The risk of injuries is a risk that the students and/or their legal guardian voluntarily agree to assume in exchange for the privilege of participating in the Museum of East Texas Art Camp. The students and/or their legal guardian understand and agree that this risk is not a risk that the Museum of East Texas assumes and that the Museum of East Texas is not responsible for any injuries to the students. Accordingly, the student and their legal guardian waive the right to sue the Museum of East Texas and its directors, trustees, officers, employees, volunteers, agents and all persons acting by, through, under, or in concert with the Museum of East Texas for any and all losses, demands, claims, suits, causes of action, liability, costs, expenses, and judgments whether arising in equity, at common law, or by statute, under the law of contracts, torts, or property, for personal injury (including without limitation emotional distress), arising in favor of the guardian, the student, or anyone claiming through us based upon, in connection with, relating to or arising out of, directly or indirectly, the student's participation in Museum of East Texas Art Camp EVEN IF ANY SUCH CLAIMS ARE DUE TO THE RELEASED PARTIES' OWN NEGLIGENCE, STRICT LIBAILITY WITHOUT REGARD TO FAULT, VIOLATION OF STATUE, OR OTHER FAULT, INCLUDING ANY NEGLIGENT ACT, OMISSION, OR INTENTIONAL ACT INTENDED TO PROMOTE MY CHILD'S SAFETY OR WELL-BEING. The student and/or legal guardian hereby grants permission to the Museum of East Texas to obtain emergency medical treatment for the student if the Museum of East Texas deems in its discretion that such emergency medical treatment is necessary.

Cancellations, Changes, or Refunds

No refunds are issued after registration, including for "no-shows," with the exception of classes canceled by the Museum of East Texas.

Valuables

The Museum of East Texas encourages its students to leave all valuables and personal items at home. The Museum of East Texas is not responsible for loss of or damage to a student's valuables or personal items.

Discipline/Dismissal

The Museum of East Texas reserves the right to remove students from classes for behavior deemed to be rude, disruptive, inappropriate, dangerous, or in violation of health and safety regulations. The Executive Director and Directors of Education maintain the right to dismiss a student from class with a prior warning, and to remove a student permanently from a class for repeated offenses.

I accept the terms & conditions listed above

Please fill out this form for each child participating in Art Camp. Once completed, you may register your child(ren) for individual classes.