Art Classes
APPLICATION
for the month of
January
February
March
April
May
June
July
August
September
October
November
December
year
2008
2009
Child's name
Date of birth
Home address
Home phone
Mother's name
E-mail
Office phone
Cell phone
Father's name
E-mail
Office phone
Cell phone
Emergency contact
Office phone
Cell phone
I hereby authorize to allow my child to leave the studio ONLY with the following persons
Name
Driver’s Lic No
Name
Driver’s Lic No
I hearby
give
do not give
my consent for my child to participate in field trips.
(To go out of the premises for sketching)
Special interests
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
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