Name of Class, Workshop or Camp Parent or Guardian Name Child's Full Name Child's Birth Date Name of School or Home Schooled Home Address City StateSelect a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 District of Columbia Zip Phone Number Parent's Email Address Names of all adults who have permission to pick up child Emergency Name Emergency Phone Number Does your child have any medical/behavioral issue of which we should be aware? Please specify. Does Catamount Arts and its funders have permission to use photos/videos of your child in promotional materials, social media, etc? Yes No Submit
