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Enrollment Form





Art Classes Application

For the month of: Year:

Child’s name

Date of Birth

Home Address

Home Phone

Mother’s name

Mother’s E Mail

Mother’s Office Phone

Mother’s Cell Phone

Father’s Name

Father’s E-Mail

Father’s Office Phone

Father’s Cell Phone

Emergency Contact Name

Emergency Office Phone

Emergency Cell Phone

I hereby authorize to allow my child to leave the studio ONLY with the following persons

Name

Driver’s License Number

Name

Driver’s License Number
I here by GIVE DO NOT GIVE
my consent for my child to participate in field trips. (To go out of the premises for sketching)
Comments:

My child attends the following school
________________________________________
Signature of Parent
________________________________________
Date

To enroll please print the filled form, sign it, include the payment, and mail it to:

Nelum Walpola
2412 Loftsmoor Lane
Plano TX 75025