Kids Like Clay™ Studio

10805 Hess Drive
La Mesa, CA 91941
(619) 567-6964
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Individual Registration

Please enter information in the form below to process registration for event Thursdays at Bird Rock Elementary - (8) Classes Winter 2023-24 year.

Child's first name *

Child's last name *

Child's grade level *

Child's Age

Child's Teacher

Classroom Number

Parent / Responsible Party's Info

Parent's first name *

Parent's last name *

Email *

Street Address

City

State

Zip

Phone *

Authorized Pick-Up Person

Pickup person's name *

Pickup person's phone # *

Special Needs / Emergency Contact

Any special needs or concerns?

Emergency contact person *

Emergency contact phone # *

Image Releases

I give permission for my child's artwork to be used by Kids Like Clay™ on its website and any other related publicity, including print and/or broadcast media. *

yes

I give permission for my child's photograph to be used by Kids Like Clay™ on its website and any other related publicity, including print and/or broadcast media. *

yes

Release of Liability

We at Kids Like Clay™ do our very best to provide a safe art making environment. In consideration for the privilege of participating in this program, I hereby release and hold harmless Kids Like Clay™ for any injuries during Kids Like Clay™ class time. Kids Like Clay™ is not responsible for children after or before the stated class times. For more information, contact Jana or Doug Kenney (619) 567-6964 or Contact Us via Email.

Please type *