Private Lesson

Unit Price

Booking Price

150.00 USD

Number of Attendees

General information

First name

Last Name

Email

Applications

Child 1 Name

Child 1 Age

Child 2 Name

Child 2 Age

Parent/Guardian Names (for children only)

Street Address

City

Zipcode

Mobile Phone

Work Phone

Home Phone

Emergency Contact Name

Emergency Contact Phone

Doctor's Name

Doctor's Phone

Photo Permission

yes

no

I grant Georgetown School of the Arts permission to use my students' photo (without name) for mailing lists and postcard advertising

State

Emergency Form

Child 1 Name

Name of person authorized to pick up your child in an Emergency:

Phone Number of person authorized to pick up your child in an Emergency:

Medical information is confidential to teachers and first aider unless it is needed for medical reasons.

Is there any special information that you would like to share that would enable us to serve your child better?

Is the child allergic to ANYTHING?

Is the child under medical care for any illness or condition?

Should the child's activities be restricted in any way?

What medications is the child taking NOW?

Does the child wear eyeglasses?

Yes

No

Does the child use an EPI Pen?

Yes

No

TOS

I hereby give my permission for my child to participate in all programs offered. I also give my permission for the Director or their designate to treat my child in the event that the parent or guardian cannot be reached in an emergency. I release and hold the Georgetown School of Arts and Paint, Draw & More! harmless from any injuries incurred in school’s recreational activities. This also gives staff permission to administer EPI Pen if indicated and to dial 911 for emergency care.

Emergency Form 2