Student Name_____________________________________________________________age___________________

Parent’s Name__________________________________________________________________________________

Will anyone besides parent(s) pick up child? If yes, names_______________________________________________

Are there any special needs we should be aware of?  If yes, please write on back or call office.
Address______________________________________City__________________ZipCode___________
Email____________________________________________ phone(s)__________________________________________

Class:      Art in the Family     Summer Art Party (day)      Summer Art Party (evening)         Creative Curators

             4 pass                 5 pass                 6 pass                 Total Paid $_____________        check    cash    credit card

Visa/MC #___________________________________________ 3 digit code ______________ exp. date________

Signature_____________________________________________________________________________________

 

Summer Art Class Pass Registration Form—Register by June 10.