Autism Arts Yarmouth - Fall 2023 Registration

Name: Autism Arts Yarmouth - Fall 2023 Registration
Brand: Art Gallery of Nova Scotia
SKU: EDU-Autism-Arts-Yarmouth-Fall23Registration-6-11
Availability: InStock

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Guardian Contact Name: First & Last Name

Guardian Contact Phone Number:

Guardian Contact Email:

Participant 1 Name: First & Last Name

Participant 1: Date of Birth (YYYY/MM/DD)

Participant 2 Name: First & Last Name

Use NA if not applicable.

Participant 2: Date of Birth (YYYY/MM/DD). Enter 0000/00/00 if not registering second participant.

Previous Participant(s). Has the participant(s) attended this program previously?

Audio/Visual Consent. Photos and videos, may be gathered during Gallery programs. Please indicate your consent or refusal to allow the Art Gallery of Nova Scotia to use this data for promotional materials (in print, on website or social media). Note participant’s name and personal details will not be shared.

Other Information. Use this space if you are registering more than than two participants to provide: Name, Age, and other required information. Use N/A if note applicable.