Application for ICP @ THE POINT s Photo Classes

Application for ICP @ THE POINT 's Photo Classes 2016

Spaces for these photography classes are limited, and slots are filled on a first-come, first-serve basis. Filling out the Online Form does not guarantee you a space in the class. Please contact Alicia or Tiffany at 718- 542- 4149 to complete your registration.
Fall 2016 Photography Classes October 13th - December 22nd

Photography I/II in Black and White for Teens – Thursdays, October 13th 4-7PM Photography I in Black and White for Preteens - Mondays, October 17th 4-7PM Photography I in Black and White for Preteens - Tuesdays, October 18th 4-7PM Photography I in Black and White for Teens – Wednesdays, October 19th 4-7PM
Child Information
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
How old is the child?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Telephone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail*
Parent/Guardian's E-mail*
Please indicate which course you are applying for:

Family Information
Total number of people living in the household*
Mother or Guardian's Full Name*

First NameLast Name
Place of Employment
Work Phone Number

Area CodePhone Number
Father's Full Name

First NameLast Name
Place of Employment
Work Phone Number

Area CodePhone Number
Pick Up Information
I give my child permission to walk home alone*

YesNo
The following adults have permission to PICK UP my child
Name*
Relationship*
Phone Number*

Area CodePhone Number
Name*
Relationship*
Phone Number*

Area CodePhone Number
Name*
Relationship*
Phone Number*

Area CodePhone Number

School Information
Name of school*
Grade*
Teacher*
Are you receiving H.S. art credit for this class?*

YesNo
If yes, provide guidance counselor information
What type of educational programming is your child enrolled in?*

Regular EducationSpecial EducationEnglish as a Second Language
If your child is enrolled in Special Education, please specify what type (i.e. inclusion, out of support)*

Medical Information
Family Clinic or Hospital*
Name of Physician*
Phone*

Area CodePhone Number
Medication currently being taken by participant:*
Allergies of participant:*
Other Medical Condition:*
Emergency Contacts

Three people who will be responsible for the child if the parent or guardian is not available:
Full Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number

Full Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Full Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number

Parent Agreement

In order for THE POINT to better serve your child, we ask that you carefully review the following guidelines for participation. By signing the consent form below, you are accepting the terms of participation and making a commitment to the overall success of the program.
Common Grounds:

* Photo classes begin on time at 12:30PM.

* Students are expected to arrive on time.

* If running late to class or absent, student and parent/guardian should contact Alicia or Tiffany 718-542-4149 or 718-542-4139 ext.141

* Each student is responsible for bringing a camera to every class. No exceptions!

* Each student is expected to be a productive and contributing member.

* Students are to be respectful.

* There is absolutely no eating in the dark room.

Attendance:

I agree to maintain consistent attendance during the program term. More the (2) unexcused absences result in student not eligible to continue. Consistent attendance is critical to keeping our doors open.

Medical:

In case of medical or dental emergency, I give permission to THE POINT CDC, to obtain necessary and immediate medical treatment for my child, with the understanding that I or a family member will be notified as soon as possible.
Parent/Guardian Signature*
Date*
Student Signature*
Date*
Camera Sign Out Form
Please bring this form the 1st day of class.

CameraSignOutForm.pdf
Photography, Writing, Video and Media Release Form
Please bring this form the 1st day of class.

PhotoModelMediaReleaseForm.pdf
Should be Empty:

Application for ICP @ THE POINT 's Photo Classes 2016

Fall 2016 Photography Classes October 13th - December 22nd

Child Information

Family Information

Pick Up Information

The following adults have permission to PICK UP my child

School Information

If yes, provide guidance counselor information

Medical Information

Emergency Contacts

Parent Agreement

Camera Sign Out Form

Photography, Writing, Video and Media Release Form