Specialspot – Children's Museum of Brownsville

Child's Name:(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth:(Required)

Age:(Required)

Child's Special Need:(Required)

Parent / Guardian Name (Mom) :(Required)

First Middle Last

Parent / Guardian Name (Dad) :(Required)

First Middle Last

Daytime Phone

Cell Phone(Required)

Email(Required)

Getting to Know Your Child: What Makes Them Shine?

How does your child respond to loud or unexpected sounds?(Required)

How does your child respond to bright or flashing lights?(Required)

Sometimes sensitive	Very sensitive	May become distressed	Not sure / Not applicable

Ask your child, please. Is there anything you would like your teachers or friends to know about you?

Ask your child, please. If you could make one special wish for your Brite’s Special Spot experience, what would it be?

Ask your child, please. What makes you smile?

Ask your child, please. What is your favorite thing to do with your family?

What is your favorite song

What is your favorite thing to play with?

What is your favorite food?

Artwork Display & Name Authorization

I-including myself, spouse, child/children/other members of my family and heirs-release and hold harmless the Children's Museum of Brownsville, its employees, volunteers, board members, and officers and related parties from all liability for lost or stolen personal items, injuries or losses as a result of attending and/or participating in any class, camp, program, tour or other function of the museum whether on-site or in transit.

I authorize the Children's Museum of Brownsville to take photographs of my child/children for marketing purposes. I give permission for pictures of my child/children to be used in the museum’s printed materials, including advertisements, brochures, flyers and website.

I authorize the Children's Museum of Brownsville to make copies, scan and/photograph handmade and/or digitally made projects created by my child for marketing purposes. My child’s artwork may be displayed at the museum and/or used in the museum’s printed materials, including advertisements, brochures, flyers and website.

I do not authorize the use of my child’s name, but I authorize the Museum to display the artwork without identifying information.

Parent/Guardian Liability Waiver & Authorization

I, the undersigned parent or legal guardian, hereby authorize the Children’s Museum of Brownsville to display and exhibit my child’s original artwork created through Museum programs, activities, or events.

I understand and agree that the artwork may be displayed within the Children’s Museum of Brownsville and/or at exhibitions, community events, educational programs, or other exhibits outside the Museum for educational, cultural, and promotional purposes.

I also authorize the Children’s Museum of Brownsville to identify the artwork using my child’s first name and, when appropriate, their age or program affiliation.

Parent/Guardian Acknowledgment

I acknowledge and understand that:(Required)

Special Spot students must be accompanied by a parent or adult for the entire class period.

Any siblings playing in the museum are required to have a parent or adult with them at all times. Special Spot students, siblings, and parents get free admission for the day.

Due to the high level of interest in this program, 3 absences in a row will result in removal from the program.

Brite Special Spot Registration

Getting to Know Your Child: What Makes Them Shine?

Artwork Display & Name Authorization

Parent/Guardian Liability Waiver & Authorization

Parent/Guardian Acknowledgment