REGISTRATION & AUTHORIZATION FORM FAIRBANKS WEAVERS' & SPINNERS' GUILD May 19 to August 15, 2008 - YOUTH SUMMER FIBER ARTS PROGRAM REGISTRATION CONTINUES THROUGHOUT THE SUMMER FEE: $80.00 per 5-day session, $70.00 per 4-day session, includes snack Noon Hour Supervision Fee: $10.00 extra. TO REGISTER: CALL 452-7737 or EMAIL info@fairbanksweavers.org or MAIL TO: Fairbanks Weavers & Spinners Guild, PO Box 73152, Fairbanks, Alaska 99707 or Visit the Weaving STUDIO, RM 219, 516 2nd Avenue, on MAY 10 -- 12 to 4pm We will respond if the session is full and your child is on the waiting list.

Child's Name______________________________________________Age____ Parent/Guardian Name_____________________________________________ Mailing Address__________________________________________________ Phones: Home______________________Work_________________________ Mom's Cell______________________ Dad's Cell _______________________ Email_________________________________________________________ SESSION(s) YOU ARE REGISTERING FOR Fee $_____Dates________Time__________Program____________________ Fee $_____Dates________Time__________Program____________________ Fee $_____Dates________Time__________Program____________________ Fee $_____Dates________Time__________Program____________________ Fee $_____Noon hour supervision -- Cost: $10 per week for _______Weeks $$$$___________ TOTAL FEES PAID WITH REGISTRATION FOR THIS PARTICIPANT

AUTHORIZATION FOR ACTIVITY -- please fill in all necessary blanks My son/daughter has permission to participate in all prescribed activities, except any noted by me: ______________________________. I recognize that my child will be participating in activities with other children and accidental injuries or illness may result. I assume the inherent risks of my child participating in the program. _______Yes____No -- I authorize my child's participation. In the event of an accident or illness, first aid will be administered and parent's emergency numbers will be called. All reasonable efforts will be made to contact parents/guardians prior to any treatment by a physician. _________ I authorize treatment of my child on an emergency basis if parents cannot be reached & the child requires emergency care by a physician. I understand the children may be crossing the street to the park for a break under supervision of instructors or assistants. I do grant________I do not grant________permission for this activity. Photographs of participants may be taken for publicity purposes in a slide show highlighting the Summer Fiber Arts Program or may be used for publicity in the Daily NewsMiner or on our web site showing projects relating to the program. In addition, photos will be used in future grant applications and brochures. _____Yes ____No. I authorize the Fairbanks Weavers & Spinners Guild to use any photographs for these purposes. I authorize the following person or persons other than myself to pick up my child or children from class: ______________________________________________________________________________ Back to Youth 2008 CHILD'S HEALTH: Any Allergies?___No___Yes --Foods?_________Bees______Other_____ Taking any Medications:___No___Yes--What kind?_______________________________________ Any precautions_________________________________________________________________ Any condition that we should be aware of _____________________________________________ Signature of the Parent/Guardian___________________________________DATE____________

Last Modified: April 21, 2008 -- c2002-2009