Name: Holter Museum of Art
Address: 12 E. Lawrence St., Helena, MT, 59601, US
Telephone: (406) 442-6400

Are you a member of the Holter Museum of Art?*
- Yes
- No
Weekly Payment*
- Block of Classes (payment by the month)
- Semester of Classes (payment for the full semester)
Week Attendance, Member Quantity

Price:
$20.00

Quantity
If you would like to pay for more than one week at a time, please note the # of weeks you will be paying for in the provided Quantity field.
This option is only available for the month of January.
Week Attendance, Non-member Quantity

Price:
$26.00

Quantity
If you would like to pay for more than one week at a time, please note the # of weeks you will be paying for in the provided Quantity field.
This option is only available for the month of January.
Camper Information
Camper's Name*

First

Last
Camper's Age*
Parent-Guardian's Name*

First

Last
Parent-Guardian's Email*
Parent-Guardian's Phone Number*
Second Parent-Guardian's Name

First

Last
Second Parent-Guardian's Contact Information
AllergiesIf camper has allergies describe all allergens, all allergic reactions and any medication (i.e. epipen, benadryl) that need to be administered.
Physical / Medical ConditionsDoes the participant have any physical or medical conditions that could result in an emergency or preclude them from engaging in certain activities?
MedicationsPlease list all medications (including over-the-counter or nonprescription drugs) taken routinely.
Social Emotional Well-being Is there anything else our instructors need to know about the participant that would help us provide the best experience for them?
Photo Release I agree to the Photo Release outlined below.I hereby grant to the Holter Museum of Art the right to use and publish photographs of myself and/or my children, or in which we may be included, for website design, editorial, trade, merchandising display and advertising for the purpose of promoting the activities of Holter Museum of Art; to alter the same without restriction and to copyright the same. I hereby release Holter Museum of Art from all claims and liability relating to said photographs.
Payment Information
Total
$0.00
Contact Email*
Billing Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Credit CardCard Details

Cardholder Name

Registration Open Art Studio Weekly Option

Camper Information

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