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Enrollment Form
Art Classes Application
For the month of:
January
February
March
April
May
June
July
August
September
October
November
December
Year:
2011
2012
2013
2014
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