Artful Summer 2017 Registration Form

Student's Information:

Student's First name:
Student's Last name:
Date of Birth:
Allergies or health alerts:

Are you registering more than one student?
Please write the other child(ren)'s name(s) and D.O.B. below:

Parent/Guardian's Information: First Name:
Last Name:
Cell Ph:
Address:
Address 2:
City:
State: Zip Code:
E-mail:
Emergency Contact:
Emergency Phone:
Artful Summer Days:

Pre-pay online: $30 per 3-hr class.
Regular Price: $35 per 3-hr class.

Choose Day(s):
June 9, 1:30 - 4:30 pm
June 16, 1:30 - 4:30 pm
June 23, 1:30 - 4:30 pm
June 30, 1:30 - 4:30 pm
July 7, 1:30 - 4:30 pm
July 14, 1:30 - 4:30 pm
July 21, 1:30 - 4:30 pm
July 28, 1:30 - 4:30 pm
August 4, 1:30 - 4:30 pm

*Supply list varies per day

How did you hear about us?

Photo Release/Waiver:
Photos may be taken during class to post on Facebook.
Yes, I give permission to the teacher to photograph my child's artwork.
Yes, I give permission to the teacher to photograph my child during art camp.

Yes! I would like to receive email updates.

For additional comments please add them below: