Register

City Kids Art Factory, Inc.

REGISTRATION FORM

Child’s Name: ____________________________________________

Check One:

Early Summer___ Late Summer___

Spring Break___ Holiday Break___

Address: ________________________________________________

City: ______________________ State : ______________

Zip Code: ______________

Gender: M_____ F_____ Age: _______ Grade: ______

School Name: _____________________________________________

Parent/Guardian Name: _____________________________________

Home Telephone: ________________

Work Telephone: ________________

Emergency Contact Person:__________________________________

Telephone: _____________________

Address: _______________________

Child’s medical or special information: _______________________________________

________________________________________

Please check all that apply:

_____ My child will walk to city kids & walk home

_____ My child will arrive by car/bus transportation & picked up after class

_____ My child will require Extended Day Services ($10 per family per week)

I give my child permission to participate in the city kids art factory, inc. visual art program, including any sponsored field trips and to appear in any promotional photographs, video, television footage, or on the CKAF website. I also understand and agree that in case of an emergency, every effort will be made to contact me or the designated contact person noted above, and that if no one is available, I give permission for my child to be treated by emergency personnel or at a medical facility. I further agree to hold city kids art factory, inc., its board of directors and staff, and facility harmless from all injuries and damages that my child may suffer as a result of participation in the art program activities. I understand that all personal information provided in this application is strictly confidential and is for internal use only.

SIGNATURE: ___________________________________

DATE: _____________

Please note the following procedures when applying for City Kids art programs:

REGISTRATION- is on a “first come, first serve basis”. You may complete a registration form on site; at our website; or by mail. All registrations have to be submitted before the session to “hold” the space.

You must submit a registration form for each session however; there is no guarantee for admission. City Kids reserves the right to equitably balance attendance to permit every child the opportunity to experience the art program.

TELEPHONE- there is no telephone registration. All names submitted by telephone will be put on a “waiting list” until there’s an opening, and a registration form is completed and submitted.

ATTENDANCE- although there is no cost to you for the program, it does cost. To permit us to fill all available openings, effectively immediately, any participant absent more than three (3) days will be dropped.

WAITING LIST- Parents who want their child to be in the program can go onto the “waiting list”, which operates on a “first come, first serve basis”. You will be notified when an opening is available. After notification, you have three (3) days to complete the registration process. If no registration is received, you forfeit the opening, and we go to the next person on the “waiting list.

Please click here to download the pre-registration form.

City Kids Art Factory, Inc. is a 501 C (3) tax exempt organization as defined by the Internal Revenue Service

Mailing address: 3832-010 Baymeadows Road, #370, Jacksonville, FL 32217 * Studio address: 1801 N. Myrtle Avenue, Jacksonville, FL 32209 * Telephone: (904) 355-2523 * Email: ckaf@bellsouth.net

Web address: www.citykidsartfactory.org.*

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