Insert Headline
Child's Name *
Age *
Address Line 2 *
City                                              State         Zip Code
Home Phone Number *
Email Address *
Parent or Guardian *
Registration Form For SplatterBox
Cell Phone Number *
Emergency Contact (Other Than Parents) *
Emergency Contacts Phone Number *
A. I/We understand that all SplatterBox classes take place at 1252 Post Road East, Westport, CT, 06880. I/We grant permission for my child to participate in all activities of SplatterBox that take place during class with the exception noted here:
B. I/We grant permission for my child to be included in pictures and promotional material directly connected with SplatterBox. No names or information will ever be given out. 
C. I/We grant permission for the staff of SplatterBox to take whatever steps may be necessary to obtain emergency medical care, if warranted. These steps may include, but are not limited to to following:
D. If we are unable to contact the parent, guardian or emergency contact person, we will do any or all of the following:
E. SplatterBox will not be responsible for anything that may happen as a result of false or incomplete information given at the time of enrollment.
F. We understand that the person associated with filing this form is responsible for any costs associated with aforementioned medical treatment(s). 
* Required Field 
- Registration is completed only upon a submitted registration form and full tuition.
- 50% of tuition will be refunded for withdrawal after registration prior to the first class. 
- No refunds will be made for withdrawal after the first class. 
- Unfortunately, at this time we're not holding make-up classes. 
- SplatterBox does not provide smocks or aprons. Worrying about keeping clothes clean can inhibit the creative            process as well as the child’s mobility. Please send them in clothing you don’t mind being embellished as a    successful day just may be a messy day! If you feel the need for your child to wear either a smock or an apron,  please send them with an over sized T-shirt for comfort and ease of mobility. 
- For our Moms, pops, and tots class, we ask that only one adult accompany your child during the class.
- Snow Day Policy: If there is a school cancellation or an early dismissal due to bad weather, SplatterBox will follow  the Westport Public School Snow Schedule. If there is only a delay, SplatterBox will follow normal store hours.

Classes And Workshop Policies
Pro-Rating
We welcome any newcomers into each session, provided there is space in the class. We are more then happy to pro-rate tuition accordingly.

- Administer First Aid
- Attempt to contact parent, guardian or emergency contact person
- Call an ambulance
- Have the child taken to the nearest hospital
What Are You Signing Up For? *
Classes : 
Workshops : 
List of Allergies *
Anything We Need To Know? *
Home Address *
Birthdays : 
Camp : 
Please Indicate Here If You Are Signing Up For Multiple Classes, Workshops, Kids Nights, Or Camps 
Age *
Total Guests Attending: 
Session:
Day: 
Date & Time Slot : 



© 2014 SplatterBox     -     1252 Post Rd. East     -     Westport, CT     -     203.349.5508     -     splatterboxart@gmail.com
I have read and agree to ALL SplatterBox policies listed on this registration form