Quisqueya Plaza HOPE Through Art Registration Form

Participate Name *

First

Last

Guardian’s Name (If applicable)

First

Last

Cell Number *

Email *

Address *

Age *

Child’s School (example P.S.189 or I.S.143, if applicable)

Child’s Cell Number (If applicable)

Child’s Email (If applicable)

Media Consent (photo and video consent) *

Yes, I consent
No, please contact me

Activities might be recorded or photographed at anytime. Consent is given by participate or the legal guardian to Helping Our People Evolve inc, Quisqueya Plaza and affiliates to photograph and record activities. These activities might be posted as promotional materials in social media to provide access to others and as media promotion.

Program Agreement *

Yes, I understand program terms
No, please contact me

1. Always be safe by being careful and show courtesy to others 2. Guardians must drop off children or provide written notice walk home 3. Use supplies provided by Quisqueya Plaza as designated for activity 4. Available for outdoor classes at Quisqueya Plaza 5. No rough play allowed 6. Free materials needed for classes will be distributed at Quisqueya Plaza. Pick up will be communicated 7. Email confirmation will be received within 24-48hrs 8. Filling out Registration does not guarantee enrollment in program 9. Each class will be once a week for 4 weeks

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Featuring Community Organizations: Helping Our People Evolve,

Empowering Our Neighborhoods Through Culture and Activities