Painters Admission Form
Now accepting painters for 2023! Please enter the following information in order to submit your admission form. If you are painting in memory of a loved one, please let us know in the "Additional Information" section below. Please email us at info@paintingsforpediatrics.com if you have any questions or need assistance with filling out the form.
NAME OF PERSON COMPLETING THIS FORM
*
First Name
Last Name
Parent or Guardian Name (Of the Painters)
*
First Name
Last Name
Painter 1
*
First Name
Last Name
Painter 1 Date of Birth
*
-
Month
-
Day
Year
Date
Choose a Canvas Size
Small (8x10)
Large (16x20)
Do you have additional painters (family/siblings) who would like participate?
Yes
No
Painter 2
First Name
Last Name
Painter 2 Date of Birth
-
Month
-
Day
Year
Date
Choose a Canvas Size
Small (8x10)
Large (16x20)
Painter 3
First Name
Last Name
Painter 3 Date of Birth
-
Month
-
Day
Year
Date
Choose a Canvas Size
Small (8x10)
Large (16x20)
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
Preferred method of communication
*
Phone
Email
Text
All
Please provide best time of day to reach you by phone
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Information you feel would be helpful.
Submit
Should be Empty: