Artist's Name (include nickname if needed)
Artist's Name (include nickname if needed)
Address
Address
Parent/Guardian Name 1
Parent/Guardian Name 1
Primary Phone
Primary Phone
Secondary Phone
Secondary Phone
Work Phone
Work Phone
Parent/Guardian Name 2
Parent/Guardian Name 2
Primary Phone
Primary Phone
Secondary Phone
Secondary Phone
Work Phone
Work Phone
I would like to be added to the mailing list to receive updates about Art Haven programs.
(This information is confidential and will not be shared with any other party)
I give permission for my child to attend Cape Ann Art Haven.
Emergency Consent Form
If you cannot be reached, and in order for Cape Ann Art Haven to protect your child in the event of a medical emergency, please complete and sign the following information. This form will accompany your child to the hospital so that medical treatment can be provided. I hereby authorize Cape Ann Art Haven staff to give consent for any emergency medical and/or surgical treatment deemed necessary for my child during class hours:
Student's Doctor
Student's Doctor
Doctor's Phone
Doctor's Phone
Date of last tetanus shot
Date of last tetanus shot
If so, please describe.
Transportation
Please list names.
My child my accompany the group, with the supervision of Cape Ann Art Haven staff, out of the Art Haven studio for field trips. (The only means of transportation would be walking.)
I give permission to have my child photographed during Art Haven classes for the purposes such as bulletin boards, newsletters, brochures, promotional materials, or grant applications.
I give permission for my child's artwork to be photographed for purposes such as bulletin boards, newsletters, brochures, promotional materials, or grant applications.

Once your application has been submitted, the Art Haven staff will contact you on the status of your application.