Emerging Artist

Child's Name

Child's age

Child's grade

Address

Parent's Name(s)

Prefered day-time phone

Emergency Information
Emergency phone: please submit the number that you can be reached during the class time and at least two, preferably three additional names and numbers to contact in case of an emergency.
Your number during class time:
Name Phone # 1
Name Phone # 2
Name Phone # 3

Please list any medical information that is pertinent to your child that could assist us in the case of an emergency. List any medications the child takes, allergies, medical conditions and the child's physician(s) and phone number(s)

Paid - circle one 4-class - 8-class - 12-class

I have read the rules with my child and understand them:

Parent's signature

Date