Arts to Music to Movies Registration 2019

ARTS TO MUSIC TO MOVIE REGISTRATION Tuesday, July 23, 2019 Ages 5+

Students will enjoy an art workshop led by award-winning fiber metal artist Linda Lindale, lunch provided by Domino's Pizza, a song-writing workshop and other activities at the GRAMMY Museum MS, and a recently released children's movie rated PG at the BPAC. Students under age 8 must be accompanied by a parent if they choose to view the movie. Museum admission is included. Students will be ready for pickup between 3:45 and 4pm at the BPAC. More information can be found online at www.grammymuseumms.org.
Child Name *

First Name Middle Name Last Name
Child Date of Birth *

Month Day Year
Child Age *
Must be at least 5 years old to participate.
Have any food allergies or medical conditions we should be aware of? *

Yes No
If yes, please elaborate here.
I understand that my child must be at least 8 years old to view the movie without supervision. If my child is between 5 and 7 years old, I will either opt them out of the movie or purchase a ticket for myself to accompany them. *

Yes
Would you like to add another child? *

Yes No
Child #2 Name *

First Name Middle Name Last Name
Child #2 Date of Birth *

Month Day Year
Child #2 Age *
Must be at least 5 years old to participate.
Have any food allergies or medical conditions we should be aware of? *

Yes No
If yes, please elaborate here.
I understand that my child must be at least 8 years old to view the movie without supervision. If my child is between 5 and 7 years old, I will either opt them out of the movie or purchase a ticket for myself to accompany them. *

Yes
Would you like to add another child? *

Yes No
Child #3 Name *

First Name Middle Name Last Name
Child #3 Date of Birth *

Month Day Year
Child #3 Age *
Must be at least 5 years old to participate.
Have any food allergies or medical conditions we should be aware of? *

Yes No
If yes, please elaborate here.
I understand that my child must be at least 8 years old to view the movie without supervision. If my child is between 5 and 7 years old, I will either opt them out of the movie or purchase a ticket for myself to accompany them. *

Yes
Would you like to add another child? *

Yes No
Child #4 Name *

First Name Middle Name Last Name
Child #4 Date of Birth *

Month Day Year
Child #4 Age *
Must be at least 5 years old to participate.
Have any food allergies or medical conditions we should be aware of? *

Yes No
If yes, please elaborate here.
I understand that my child must be at least 8 years old to view the movie without supervision. If my child is between 5 and 7 years old, I will either opt them out of the movie or purchase a ticket for myself to accompany them. *

Yes
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Phone Number *

Area Code Phone Number
Parent/Guardian Phone #2

Area Code Phone Number
Parent/Guardian E-mail *
Please email me about future events and programming at: *

Bologna Performing Arts Center Delta Arts Alliance GRAMMY Museum MS None of the above
The following person will pick my child up between 3:45 and 4pm on July 23rd at the Bologna Performing Arts Center (after the event):
Name *

First Name Last Name
Relationship *
Contact Number *

Area Code Phone Number
In case of emergency...
Emergency Contact #1 *

First Name Last Name
Relationship *
Contact Number *

Area Code Phone Number
Emergency Contact #2 *

First Name Last Name
Relationship *
Contact Number *

Area Code Phone Number

Ticketing Options *

Full Day Ticket (child 8 or above will attend movie) $ 40.00

Quantity

Partial Day Ticket (child under 8 will not attend movie) $ 35.00

Quantity

Full Day Ticket (child under 8 WILL be accompanied in movie by adult *must also purchase adult movie ticket*) $ 40.00

Quantity

Movie Ticket (adult chaperone) $ 5.00

Quantity

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Should be Empty:

ARTS TO MUSIC TO MOVIE REGISTRATION Tuesday, July 23, 2019 Ages 5+