Art for All with Mr. Paul High Horse Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. St., Media Fall Fall Art For All Classes at SPLECC 1500 N 16th St., Council Bluffs, IA 51501 *Mom’s Night Out Class (with babysitting available): Monday Evenings October 5th – December 7th (6:00pm – 7:15pm)High School Art Class – Wednesday Evenings , October 7 – December 9th (4:15pm – 5:15pm)Veteran’s Art Class: Wednesday Evenings, October 7th – December 9th (6:00pm – 7:00pm)Please select which Art Class you are signing up for. For questions, please call 712-322-3294 or email: [email protected] or [email protected] Name *FirstLastEmail *Cell Phone Number *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeArtistic ExperienceNoviceAmatureExpertEmergency Contact Name *FirstLastEmergency Contact Phone # *Any Medical Conditions?Liability Waiver Agreement *YesNo“Participants and their parents hereby agree to indemnify and hold harmless St. Paul’s Evangelical Lutheran Church of Council Bluffs, IA, its officers, board members, employees, and volunteers, from and defend against all claims brought or actions filed, for any and all claims, suits, actions debts, damages, costs, charges, and expenses including court costs, and attorney’s fees, and against all liability, losses, and damages of any nature whatsoever, including but not limited to property damage and personal injury, including death resulting at any time there from, arising from any alleged acts of negligence, either active or passive, of the participant or any person acting on his/her/its behalf arising from the activities which are the subject matter of this contract.”Photography / Social Media Waiver *YesNoI hereby give permission for photographs taken during Camp Creation I to be used by St. Paul’s Evangelical Lutheran Church of the above student(s) to be used for promotional purposes, including fliers, websites, Facebook, Instagram (Social Media Pages), news features, etc.Waiver & Photo/Social Media Agreement Date *Please enter today’s dateParental Consent Signature *FirstLastPlease enter your full legal name to acknowledge the Liability & Photograph/Social Media Permission Waiver. NOTE: Only needed for participants under the age of 18.Submit