Information Form for Children

Your child's safety is a top priority for us. ALL REGISTRANTS enrolled in a class with the Southampton Arts Centre must have a parent/guardian complete the information form below. If you are enrolling multiple children, they can all be included in the same form. Thank you!

* Indicates required field

Parent/Guardians First and Last Name *

Contact Email *

Phone # where a parent or guardian can be reached during classes *

Address *

City *

Province *

Postal Code *

Each Child's Name(s) and Ages *

List the class name in order of child's name. *

Date of Class and AM/PM *

We occasionally take photos for our Facebook page and website. Do we have your permission to take photos of your child? *

Yes No

Does your child have a medical condition of which we should be aware? (eg. asthma, epilepsy, allergies) *

YES NO

If you answered YES to the previous question please describe *

Submit

GET IN TOUCH

Southampton Arts Centre
Art School & Gallery
3-201 High Street,
Southampton, Ontario N0H 2L0
Telephone: (519) 797-5068
Toll Free: 1-800-806-8838
Email: info@southamptonartscentre.com

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