Register Form

学生报名表

UNIQUE ART STUDIO

2001 Junewood Ave, San Jose, CA 95132

650-210-6739

Course Title

上课开始时间 Start Time

Day

Sat

Student’s Name

First Name

Last Name

Date of Birth

YYYY

Parent’s Name

First Name

Last Name

Parent's Phone

(###)

###

####

Emergency Contact (Name)

First Name

Last Name

Phone

(###)

###

####

Emergency Form

I hereby grant permission to Unique Art Studio personnel to arrange transportation for (name of student)__________________ in case of accident or accrue illness and to arrange for medical dental and /or surgical care at the uninsured expense of this service will be assumed by me.

Waiver/Release of Liability

I give permission for my child (name)___________________________________________ to participate in the activities of the Unique Art Studio Program. I give my permission to the studio personnel to take full charge of any emergency in the event all the above said persons are unable to reached. I will not hold the studio or any staff members liable in the case of accidents or injuries. I have studied the Policy of Unique Art Studio and will agree to follow them as required by the studio.

本人准许我的子女参加Unique Art Studio的教学活动。家长监护人联络不到时，本人准许画室负责人全权处理意外事件，如有任何意外发生，本人不以画室人员为责。我已经知道上课须知中的规定，我同意并且尊守这些规定。

Agree

Parent/Guardian’s Signature

First Name

Last Name

Date

YYYY