First name
Middle name
Last name
School
Grade
Age
Date of Birth
Male/Female
MaleFemale
Home Address
Home Phone
Mobile
Email
Medical Information
-Any Allergies (e.g, Foods, Insect stings, dust) or other medical conditions (e.g, Asthma, Diabetes, Epilepsy)-
-Any Information that Art School needs to know
Parent / Guardian Details
Parent1 / Guardian1
Full Name
Relationship to student
e-mail
Parent2 / Guardian2
Full name
Siblings
Siblings1
Grades
Siblings2
Siblings3
Siblings4
* If Parent or Guardian can not be contacted or unable to pick your children up.
Relationship
Photo / Video Consent Agreement Idodo not give permission for students Photos, videos and Art works to be published on social media websites (e.g, Facebook, Instagram, Website and YouTube) brochures, flyers and other displays both inside and outside of the school.
*Tick or Fill in the blanks below
Day MonTueWedThuFriSat
Time (e.g, 3:30pm-5:00pm)
Payment TermlyMonthlyDaily
Date: Print Name:
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