Current Teen Programs | ArtFusion 19464

Fill out the form below to register your teen (ages 13-18) to attend our free Teen Art Social program. The program starts September 15 and runs every Tuesday from 4:30-6:30pm through December 8.

This is a drop-in class. Students can attend as many classes as they like during the 12 weeks of our fall session. They do not need to sign up for a specific date. However, any student who wishes to participate must have a current registration form on file with us.

Each class begins with a short art lesson. Then teens can either work further on the lesson of the day, or work independently on a project of their choice. The instructor is there to help with whatever they wish to work on. We will have art supplies available for students to use, or they can bring their favorite materials with them to class.

This program is made possible by a generous grant from the Greater Pottstown Foundation.

Class Registration

Today's Date*
Month
Day
Year
Class(es) Attending and Start Date(s)*
Class Start Date

Click the plus icon to enter additional classes/start dates.
Student Name*
First Last
Student Age*
Is this student homeschooled?
- Yes
- No
(Applies to child or teen student only.)
School District
(Applies to child or teen student only.)
Does the student qualify for free or reduced lunch?
(Applies to child or teen student only.)
- Yes
- No
Parent/Legal Guardian Name*
First Last
Please enter the parent/legal guardian name if student is a minor.
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Email*
Enter Email Confirm Email
Would you like to be added to our email newsletter?*
- Yes
- No
Please check any item we need to be aware of. (This information will be kept confidential and is important for us to know.)
- Allergies
- Medication Needed
- Behavior
- Medical Issues
- Other
If you checked any options above, please explain
Emergency Contact
Please list at least one emergency contact.
First Emergency Contact Name*
First Last
Relation*
Phone*
Second Emergency Contact Name
First Last
Relation
Phone
ArtFusion 19464 reserves the right to take pictures of students and/or students’ work for promotional materials.*
- Yes, you may use photos of me/my child.
- No, please do not use and photos of me/my child.
Class Policies*
Class policies can be found here: https://artfusion19464.org/about/class-policy/
- By checking here, I acknowledge I have read and understood the class policies, including the Code of Conduct.
Consent and Release
On my own behalf or on behalf of my minor child (hereinafter referred to as “Student”), I hereby allow such Student for whom I am the legal guardian, to participate at an ArtFusion 19464 Art Class (hereinafter referred to as “Art Class”) sessions. In consideration of ArtFusion 19464 making this opportunity available to the Student, I hereby agree to release, indemnify and hold harmless ArtFusion 19464 (and their officers, employees, agents, volunteers, and Board Members), from and against any and all claims, demands, liabilities, losses or expenses, including attorney fees, and including injury to Student or other party, associated with Student’s participation in Art Class (including but not limited to those arising in connection with field trips, and any transportation to and from such field trips, the use of the School’s equipment or facilities, and those arising from any act or omission of third party due to student’s own conduct). I further agree that is any part of this agreement is found by a court or other appropriate authority to be invalid, the remainder of the agreement nevertheless will appropriate authority to be invalid, and the remainder of the agreement nevertheless will remain in full force and effect.
Consent and Release Acknowledgement*
- I acknowledge that I have read and understand this Consent and Release, and voluntarily agree to be legally bound by its terms.
Medical Waiver*
- I hereby grant ArtFusion 19464 (and their officers, employees, agents, volunteers, and Board Members), permission, at their discretion, to seek and authorize emergency medical treatment for myself or my child and I hereby agree to assume all medical costs incurred. I have included any additional medical information that ArtFusion 19464 needs be aware of in this form.
Additional Information
How did you hear about ArtFusion 19464?
- Online search
- Friend
- Walking by
- Other
If you chose Other, please elaborate.
If you were referred to us, whom can we thank?
Would you consider volunteering for our non-profit art center?
- Yes
- No
In what capacity could you best assist?
Sponsorship
I am affiliated with a business that would like information on sponsorship opportunities.
Additional Comments
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Additional Information