ACT Art Club Registration | Grades 4 - 6
Fill out the form below to register for the ACT Art Club.
You will receive a confirmation email when your registration is complete. If you do not receive a confirmation email, please check your junk mail.
Child Information
Child's First Name
Child's Last Name
Birthdate
School Child Currently Attends
Grade
Please select...
4
5
6
Does your participant have any medical conditions, allergies, or medications we should know about?
Yes
No
If yes, please specify below
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Phone Number
Email Address
Address
Town/City
Postal Code
Do you want to be added to the ACT mailing list?
Yes
No
Emergency Contact Information
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone Number
View the photo/video consent terms
I have read and agree to the photo/video consent terms and
I grant MCRC permission to use photos of my participant on their social media accounts, website, and on promotional materials.
Payment Information
Total Amount Due:
$70 (
Reduced Price for Late Start - Includes supplies)
Name on Card
Card Number
MM
YY
Code
Billing Email
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Contact Information