First Name
Last Name
Date of Birth:
Age:
Phone Number:
Email:
Street Address:
City
State/Province
Postal/Zip Code
Parent/Guardian Name:
Parent/Guardian Phone Number:
Parent/Guardian Email:
Emergency Contact Name:
Emergency Contact Phone Number:
Medical Conditions/Allergies:
Previous Art Experience:
What are you hoping to learn in this class?
How did you hear about this class?
Class Name/Title:
Class Day and Time:
Class Start Date:
Class Fee:
Alternate Class Choices (In case the first choice is full):
Payment Method:
Billing Address (if different from student address):
Photo/Video Release (Allowing the use of student artwork/photos for promotional purposes):
Liability Waiver (Releasing the art school/instructor from liability for accidents):
Refund Policy Acknowledgment (Stating the refund policy clearly):
Code of Conduct Agreement (If applicable):
Parent/Guardian, please sign here.
Scholarships/Financial Aid (If offered, include application information):
Materials List:
Special Needs/Accommodations (If the student requires any special accommodations):
Form Template Instructions
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Strengths:
Potential Areas for Improvement: