Complete one form per child

Child's Full Name
Field is required!
Field is required!

Select Your Child's Age

Field is required!
Field is required!
Child's Grade
Field is required!
Field is required!
School
Field is required!
Field is required!

How would you describe your child's writing?

Field is required!
Field is required!

Child's Wellbeing

List any food allergies and reaction
Field is required!
Field is required!
Describe any emotional/ medical or other conditions we need to know about.
Field is required!
Field is required!

Parent's Information

Parent's Full Name
Field is required!
Field is required!
Your Phonenumber
Invalid phonenumber!
Invalid phonenumber!
Email address
Field is required!
Field is required!
Your Address
Field is required!
Field is required!

Emergency Contact

Fullname
Field is required!
Field is required!
Your Phonenumber
Invalid phonenumber!
Invalid phonenumber!

How did you hear about this tour?

  • - select media -
  • Website
  • Friend
  • Advertisement
  • Next Door App
  • Facebook
  • Instagram
- select media -
Field is required!
Field is required!

Consent

By clicking SUBMIT I agree and give my consent to the following: The Next Star Arts Program (Next Star) staff takes all necessary precautions to ensure the safety of the students in their care. I agree to hold harmless Next Star or its partners, their agents, officers and/or employees from all claims, damages, injuries, or other liabilities of any kind whatsoever that could be brought now or in the future by me arising from any action or inaction. I understand that certain reasonable risks may exist in allowing my child to participate in the program. I agree to be responsible for all medical bills, costs, and expenses (including ambulance services) incurred in providing necessary care to my child, and/or I authorize the direct billing of my health insurance carrier. In cases of emergency, Next Star shall act merely as my agent and neither Next Star nor the staff or volunteers shall incur any liability for the good faith exercise. I understand that my child may appear in photographs and videos taken in the normal course of this tour. I hereby authorize Next Star and to use such images and video for promotional purposes only. I will drop off and pick up my child from the restaurants on time. Note: Next Star will not provide transportation to participants.