-
-
-
-
-
-
-
-
Medical History Please provide details where requested, or indicate "None or N/A:
-
-
-
-
-
-
-
ACKNOWLEDGMENT OF RISK AND CONSENT FOR TREATMENT
I, the undersigned, hereby acknowledge that certain risks of injury are inherent to any children’s program, including but not limited to
participation in classroom, recreational activities, sporting activities, lesson/laboratory experiments, transportation to, from the
program, child’s failure to follow instructions of supervisors, communicable illness, and independent acts of third parties not under the
control of supervisors. I acknowledge that all risks cannot be prevented, and assume those beyond the control of the Ai
Studios staff. These types of injuries may be minor or serious and may result from one’s actions, or the actions or inactions of
others or a combination of both. I will take responsibility to see that my child is prepared for all activities and is in good health each
day of the session. I hereby assume all risks associated with participation in Ai Studios programs and agree to hold harmless
Ai Studios, its directors, officers, employees, agents, representatives, counselors, volunteers, et al from and against any
and all claims, demands, losses or liability of any kind or nature which may arise in connection with injuries suffered to my child while
enrolled/participating in their program. In case of medical emergency, I understand that every reasonable attempt will be made to
contact me or the emergency contact named below. However, in the event that I or my named contacts cannot be reached, I give my
permission to the adults in charge of the programs to secure and receive emergency medical or first aid treatment for my child,
including transport via ambulance to a hospital if necessary. I consent to the sharing and release of any medical information listed
above with the appropriate staff members of the program and/or medical personnel that may be necessary to ensure the safety and
wellbeing of my child. I agree to pay for any charges for emergency medical treatment that are not covered by my personal health
insurance.
-
I have read and understand the above informed consent agreement in its entirety and hereby give my consent for my child to participate knowing all of the foregoing.
-
-
-
-
Please sign in the gray box on the black line the best you can, thank you.
Class Selection
-
-
-
-
Payment Options:
Checks payable to: Ai Studios, PO Box 33, Towaco, NJ 07082
Please submit checks with this application, returned check fee $35.00
-
-
-
Please sign in the gray box on the black line the best you can, thank you.
The registration and program fee for Ai Studios Enrichment Program is nonrefundable. This payment is due with the completed registration form. There is limited space available in the program. A space is not held or secured until a completed registration form is received with full payments for the classes.
Release of Image:
I grant my permission for Ai Studios to photograph, videotape, and/or audiotape myself or my child during classes & activities. The photographs / videos / audios remain the property of Ai Studios and may be used for advertising or promotion in any medium without further compensation. I understand my child will not be identified by name unless I give my express permission.
I hereby waive and release on behalf of myself and my child, any rights to ownership of such images and/or sounds, and any right to inspect and/or approve the finish product or advertising copy in connection therewith.
(Please check only one of the following)
-
-
OUR POLICIES:
Tuition must be paid at the time of registration. Any registration form received without the required tuition will be returned and the student will not be registered for classes.
• Refund Policy: Refunds will not be given for any reason. Supply fees are not refundable.
• There will be no refunds for one-evening classes, or for trips unless otherwise noted.
• If Artistic Impressions Studio cancels a class, the tuition will be applied to another class.
• Student absences are non‐refundable. The school is not responsible for make-up classes; unless it is due to bad weather (only one make up class will be granted). In these circumstances a make‐up class will be available with the discretion of Ai Studios. One make-up class can occur only during the same semester with the same instructor. If students are late for class, there will be no make‐up time.
• Conduct: We reserve the right to refuse admission or to expel any disruptive student. Cell phone usage is not permitted during class time. Cell phone should be placed on silent or vibrate in the classes. Unregistered children and parents cannot enter class rooms. Children cannot accompany adults to classes ‐ no exceptions.
-
-
Please fill out and sign the form completely and print. Then, either mail the signed form to:
Ai Studios, POB 33, Towaco NJ 07082
or scan it and email it to aistudios@optimum.net