Student's Name *

First Name

Last Name

PAYMENT METHOD *

This form is a REQUEST. Your payment is not yet due. We will contact you via phone or email to book your Date/Time. Once we have finalized the Date/Time your full payment is due to complete your registration. Once we receive your Payment via Zelle or Venmo we will confirm your booking from the email freewooodscreativecollective@gmail.com

ZELLE (Wait for a Request for Payment to the email address you have provided below)

VENMO (Wait for a Request for Payment to the email address you have provided below. This method of payment will include an additional fee of 1.9% +0.10.)

Parent/Legal Guardian 1 Name *

First Name

Last Name

Parent/Legal Guardian 1 Cell Phone *

(###)

###

####

Text Authorization

Check if we may contact you via text regarding emergency class cancellations

Primary Address of Student Parent(s)/Legal Guardian(s) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Legal Guardian 2 Name

First Name

Last Name

Parent/Legal Guardian 2 Cell Phone

(###)

###

####

Text Authorization

Check if we may contact you via text regarding emergency class cancellations

Parent/Legal Guardian 2 Address

IF DIFFERENT THAN STUDENT'S ABOVE

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 1 *

All Emergency Contacts must be authorized by you to pick up your Child from Class in the event that you are Unable

First Name

Last Name

Pickup Pre-Auth *

I pre-authorize my Emergency Contact to pick up my child in the event that I am unable. I will inform the Freewoods Creative Collective staff immediately of any changes to my Emergency Contacts/Authorized Pickup Persons

Emergency Contact 1 Phone *

(###)

###

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Emergency Contact 1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact 2 *

All Emergency Contacts must be authorized by you to pick up your Child from Class in the event that you are Unable

First Name

Last Name

Emergency Contact 2 Cell Phone *

(###)

###

####

Emergency Contact 2 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PHOTOGRAPHY WAIVER

PHOTOGRAPHY WAIVER I give consent for myself or my child to be photographed, videotaped or filmed while participating in "FREEWOODS FILMS LLC" activities and for the resulting images and voices to be used by "FREEWOODS FILMS LLC" for promotional purposes. Children's names will never be released/displayed in any public forum (including print and/or social media) in conjunction with their picture.

Yes

No - Your children's face will be blurred or electronically covered to conceal their identity

Date *

MM

DD

YYYY