Art Program Registration

Dates: Jaunary 11, 18, 25, and February 1, 8, 15, 22
Time: 4:00 - 5:00 pm
Location: Michaels at 7630 N Division Street, Spokane Wa 99208

Please Note: All fields below that are marked with an asterisk are required.

Participant Information

First Name *
Last Name *
Birthdate *
Shirt Size *
How did you hear about PASS?

Medical Information

Insurance *
If unknown or not applicable please type NA.
Known Allergies *
If unknown or not applicable please type NA.
Medical Condition(s) *
If unknown or not applicable please type NA.
Medical Equipment (E.g., pacemaker or walker) *
If unknown or not applicable please type NA.
Medication(s) (E.g., blood thinners) *
If unknown or not applicable please type NA.
What can you tell me about your artist?
Please tell me anything you think would be helpful for me to know.

Parent/Guardian Information

We will assume you are "Parent/Guardian 1" and will use the information entered in the "Parent/Guardian 1" section for all future correspondence.

Parent/Guardian 1

First Name *
Last Name *

Address *

City *
Zip *

Main Phone *
Other Phone (Work, Home, etc.)

Email *
Relationship to Artist *

Parent/Guardian 2

First Name
Last Name

Address

City
Zip

Cell Phone
Other Phone (Work, Home, etc.)

Email
Relationship to Artist

Emergency Contact Information

Please list someone other than yourself.

First Name *
Last Name *
Phone *

Policies & Waivers

Read the refund policy »
Read the all-claims statement »
Read the media release »
Please check one of the boxes below to allow or disallow PASS to use images. *
Yes, I agree to allow PASS to use my child’s image in photos/videos for promotional use.No, I do not want PASS to use my child’s image in photos/videos for promotional use.
Registration Fee is $30 and goes towards an art Shirt, awards party, and operational costs. All staff are volunteers allowing all funds to be used for the program.
Please prove you are human by selecting the Flag.
Clicking "Submit Registration" above will redirect you to PayPal to complete the payment process.
You do not need to have a PayPal account.