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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