Register Here

Please fill out this information if you are registering for a program through this site. We will not share this information with anyone outside of our organization. We collect it to protect your child, to ensure we are acting in a manner that the child’s parents would like, and to protect our organization.

Thank you!

Child's Name *
Child's Name
Must be in Grades 3-5
Phone *
Phone
Phone 2
Phone 2
Emergency Contact Phone Number *
Emergency Contact Phone Number
Video Release *
I do hereby grant to West Plains Arts Academy and its authorized representatives permission to record on photography film and/or video, pictures of my child's participation. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochures, or other printed materials used to promote WPAA, and further that such use shall be without payment of fees, royalties, special credit or other compensation. I do NOT hereby grant to West Plains Arts Academy and its authorized representatives permission to record on photography film and/or video, pictures of my child's participation. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochures, or other printed materials used to promote WPAA, and further that such use shall be without payment of fees, royalties, special credit or other compensation.
Medical Release *
I do hereby state that I have legal custody of the aforementioned minor(s). I grant my authorization and consent for West Plains Arts Academy (hereafter WPAA) staff to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor while participating in WPAA activities. If the injury or illness is life threatening or in need of emergency treatment, I authorize the WPAA staff to summon any and all professional emergency personnel to attend, transport, and treat the minor. I agree to assume financial responsibility for all expenses of such care.
Liability Release *
I agree for my child to participate in a West Plains Arts Academy (hereafter "WPAA") activity, and hereby release WPAA, its trustees, board, instructors, volunteers and employees from liability for any injury my child may suffer as a result of his/her participation.