Name: Snow Day Dachshund
Start: 2025-12-06T13:00:00-05:00
End: 2025-12-06T15:00:00-05:00

Design a dachshund pup playing in the snow using paint techniques and paper collage!

Helen Smith Registration Request

Submitting a registration request form is not a guarantee of enrollment; you will receive email confirmation (or regrets) based on availability. Preference is given to first-time participants.

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Student's Information
Name of Student*
First Last
Age of Student*
Workshop Requested*
Parent/Guardian's Contact Information
Parent/Guardian Name*
First Last
Email (Parent/Guardian)*
Parent/Guardian Phone*
Will you be available by phone during the workshop, in case of emergency?*
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Emergency Contact(s)
First Additional Emergency Contact*
First Name Last Name Phone Number
Second Additional Emergency Contact*
First Name Last Name Phone Number
Health Information
Are there any health considerations (physical, psychiatric, or behavioral) we need to be aware of?*
- No
- Yes (explain below)
Explain health considerations (if any)*
This information will be kept confidential and only disclosed to the instructor on a need to know basis.
Are there any medications, allergies, special needs, etc. we need to be aware of to ensure that your child’s experience is positive?*
- No
- Yes (explain below)
Describe any medications, allergies, special needs, etc. we need to be aware of:*
This information will be kept confidential and only disclosed to the instructor on a need to know basis.
Pick Up Authorization
Persons authorized to pick up student after class
Person 1*
First Last Relationship to Student
Person 2*
First Last Relationship to Student
Person 3
First Last Relationship to Student
Person 4
First Last Relationship to Student
Waiver
Consent*
I agree to the policies described below
The undersigned does hereby release, forever discharge and agree to hold harmless The Delaplaine Arts Center, Inc., its board, staff, and agents from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in Delaplaine activities. The undersigned further consents to the administration of first-aid and/or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may be required. In the event or the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify said The Delaplaine Arts Center, its board, staff and agents from any acts of malfeasance, and/or failure to act on the part of those chosen to help or to administer medical care on behalf of the participant.

The Delaplaine routinely captures photos and videos during classes, events, and programs. Images may be used online or in print to promote the Delaplaine Arts Center and its mission. If you DO NOT wish to appear in Delaplaine photos or videos, please notify Delaplaine staff or email your request to info@delaplaine.org.
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Snow Day Dachshund

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Helen Smith Registration Request

Student's Information

Parent/Guardian's Contact Information

Additional Emergency Contact(s)

Health Information

Pick Up Authorization

Waiver

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