REGISTRATION

IMPORTANT – Please complete the following detail form, or download and bring the enrollment form with you the first day of class.

* NOTE: STITCHOLOGY STAFF CANNOT ADMINISTER ANY MEDICATIONS TO YOUR CHILD UNDER ANY CIRCUMSTANCES.

Student registration

Mother/Guardian Full Name

Email Address

Father/Guardian Full Name

Parent Phone

Home Address

City

State

ZIP

Child Full Name

Age

Grade (entering Sept.)

Health Notes

Emergency Contact Name

Relationship

Emergency Phone

SESSION SESSION SESSION 1 - July 1, 2, 3 SESSION 2 - July 9, 10, 11 SESSION 3 - July 16, 17, 18 SESSION 4 - July 23, 24, 25 SESSION 5 - August 6, 7, 8 SESSION 6 - August 13, 14, 15 SESSION 7 - August 20, 21, 22

CLASS TYPE CLASS TYPE BEGINNER - AM CONTINUING - PM

PARENTAL AUTHORIZATION

BY SUBMITTING THIS FORM I ACKNOWLEDGE:

I have read, I understand and I agree to the rules that have been set forth in this REGISTRATION FORM.

I indemnify and hold Stitchology and Jane Bessette harmless against claims and damages arising against Stitchology and Jane Bessette.

In the event of an emergency, I give my permission to have my child treated by medical personnel.

I understand that this program does not carry accident insurance and that I am financially responsible for any expenses for medical care or transportation incurred on my child’s behalf.

I give permission to have my child photographed / videotaped for publicity or news story purposes.

SEND ME INFO ABOUT UPCOMING KIDS WORKSHOPS AND PROGRAMS!

We are always thinking up new projects and ways to introduce kids to the artful science of sewing! Sign up today to get info on upcoming Stitchology workshops and classes.