Afterschool STEAM Program Registration

Registration Form for OpenDoors Afterschool STEAM Program

Internal form: Only for families of OpenDoors Asheville who are registering for the afterschool STEAM program.

Student Information

Student First & Last Name:(Required)

Student - Grade in fall:(Required)

Student - School in fall:(Required)

Student - Health insurance (Please provide the student's health insurance company and policy number):(Required)

Student - Special information (Please include allergies, special needs, or other information we should know):(Required)

Photo Release:(Required)

Yes (I will allow photos of my student to appear in publications or promotional materials for the Asheville Art Museum)

No (I will not allow photos of my student to appear in publications or promotional materials for the Asheville Art Museum)

Student Artwork Release: Part of this program includes a display of student artwork in the Museum's educational Blossman Gallery. Student work will be on display to the public, including all Asheville Art Museum visitors. Please indicate whether you give the Asheville Art Museum permission to display your student's artwork:(Required)

Yes (I will allow my student's artwork to be displayed for public view at the Asheville Art Museum, including their name)

Yes (I will allow my student's artwork to be displayed for public view at the Asheville Art Museum, but please write their name as "anonymous")

No (I will not allow my student's artwork to be displayed for public view at the Asheville Art Museum)

Approved Adults for Pickup (Provide names/phone numbers for all adults authorized to pick up the student):(Required)

Parent/Guardian Information

By completing the online registration process, you, as the parent or guardian of the named minor child: • Give your consent and approval for his/her participation in the Asheville Art Museum’s Summer Art Camp; • Authorize any medical treatment which may be advised or recommended by an attending physician while the named minor child is participating in the program; and • Will not hold the Asheville Art Museum responsible in case of accident as a result of participation. • Acknowledge the contagious nature of COVID-19 and voluntarily assume the risk of being exposed to or infected by COVID-19 by participating in programs at the Museum and that such exposure or infection may result in personal injury, illness, permanent disability, or death. • Accept such risks and volunteer to participate with full understanding of the dangers involved. By participating in this program, I hereby waive and release the Museum, its employees, agents, officers, and representatives from any and all claims, costs, liability, and expense for any injury, loss, or damage whether known, anticipated, or unanticipated arising from my voluntary participation in this program.(Required)

Approved

Your Name:(Required)

Phone Number:(Required)

Email:(Required)

Email Confirmations—Please add @ashevilleart.org to your email safe list. The Museum has been experiencing issues with our emails going to spam folders instead of your inbox. If you have not received a response to this request within 5 business days, please check your spam folder.

I have read the above notice regarding email confirmations and will mark @ashevilleart.org as a safe email.

Registration Form for OpenDoors Afterschool STEAM Program

Student Information

Parent/Guardian Information

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