Forms — STUDIO 11 ¾

Click button below to download and print form, fill out and return by scan and email to studio11and3quarters@gmail.com

or deliver to Francine Winters’ box at: The Marius Building, 100 N D St., Public Health, Suite 101, Lakeview, Or 97630

Minor Media Release Form

Youth Program Permission Slip

studio11and3quarters@gmail.com
(541) 417-2843

STUDIO 11 ¾

11 North G St.
Lake County Senior Center
(second door, under the awning)
Lakeview, OR 97630

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Disclaimer: This institution is an equal opportunity provider and employer.If you wish to file a Civil rights program complaint of discrimination,complete the USDA Program Discrimination Complaint Form, found online at https://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office,or call (866) 632-9992 to request the form. You may also write a letter containingall of the information requested in the form. Send your completed complaint formor letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication,1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.