Art Program Registration

    Winter 2023 Art Program Information

    Dates: February 18, 25, March 4, 11, 18, 25, and April 1
    Time: 11:00 AM – 12:00 PM
    Location: Spokane, WA 99203 – Address will be provided in the confirmation email
    Instructor: Josie, PASS Vice President


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

    Artist Information

    First Name *

    Last Name *

    Birthdate *

    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 *


    Registration Fee

    Registration Fee is $35 and goes towards art supplies, an art show, and operational costs. All staff are volunteers allowing all funds to be used for the program.


    Submitting Your Registration

    Clicking “Submit Registration” below will redirect you to PayPal to complete the payment process. You do not need to have a PayPal account to complete the payment.


    REFUND POLICY

    PASS understands that special circumstances may occur in which a participant cannot participate in our registered sport or art programs. Any cancelled registrations maybe subject to a $15 Administration fee.

    • Refunds are issued in the form of a check.

    • All Registration cancellation requests will go through the PASS Coordinator.

    MEDIA RELEASE

    PASS publishes in print, electronic or video format the likeness or image of your child for official publications. I agree to allow photographs related to my child’s PASS activities to be used by the organization to help promote its mission. I understand PASS owns rights to any and all photographs of which my child may be a part.

    RELEASE OF CLAIMS

    In consideration of permission granted to my child/ward by PASS to participate in sports and social activities, I, the parent or guardian of the above named child, hereby release and discharge PASS, its officers, representatives, and coaches/instructors/volunteers from all claims, demands, actions, judgments, and executions which the child, parent or guardian ever had, now has, or may have, or which the child or parent or guardian’s heirs, executors, administrators or assigns may have or claim to have, against PASS its officers, representatives, coaches/instructors/volunteers, their successors or assigns, for all personal injuries, known or unknown to my child/ward, and injuries to property, real or personal, caused by, or arising out of, the above described sports or social activity. I, the parent/guardian, have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance.