Register for Classes and Camps

Student(s) First and Last Name

Student(s) Date of Birth/Grade

Program(s) Selected (required)

Parent Name

Your Email (required)

Address, City State Zip

Phone (required)

Cell Phone (required)

Emergency Contact & phone #

How Did You Hear About Us?

AdInternet SearchFriendSchool RecommendationPersonal RecommendationNewspaperOther

Payment via Zelle

-payment made via Zelle (201-341-7714)Check payable to Bass Arts Studio mailed to: 202 Park St. Montclair, NJ 07042-

Tuition Amount Paid

Photo Release: Bass Arts Studio DOES/DOES NOT have my permission to use photos of my child for publicity.

YESNO

I/ we the parents of the above named child do hereby give my/our approval to participation in any and all of the activities. I/We do assume all risks andhazards incidental to the conduct of the activities and transportation to and from activities; and do further hereby release, absolve, indemnify and hold harmless Bass Arts Studio and the organizers and supervisors, any or all of them. In case of injury to my/our child, I/we hereby waive all claims against theorganizers, the sponsors or any supervisors appointed by them.

YESNO

Comments & Concerns or special needs (allergies)

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