ART-RAGEOUS SUMMER CAMP REGISTRATION

Number of Children Registering: Parent #1 First Name: Parent #1 Last Name: Parent #1 Email: Parent #1 Phone Parent #2 First Name: Parent #2 Last Name: Parent #2 Email: Parent #2 Phone: Home Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix I ________________ including my spouse or other members of my family, do hereby release and hold harmless Young At Art Museum, its employees, board members and related parties from all liability for lost and stolen personal items, injuries or losses as a result of attending and/or participating in any childcare, art program, workshop class, camp, program, tour, YAA Fun Zone, or other function of the museum and hereby consent and agree to the guidelines set forth on these forms