Anna Banana Registration

Student Information Form
Student Information

Please give us some information about the student.
Has the student attended an Anna Banana class or camp before?*

YesNo
Has any major information (cell phone, address, allergies, etc.) changed since then?*

No, everything is the same.Yes, we've had some changes.
Student First Name*
Last Name*
Date of Birth: month/day/year*
Gender*
Grade in School*
Parent Information
Parent First Name*
Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Number

Area CodePhone Number
Cellular Number*

Area CodePhone Number
E-mail*
Medical
Please list any medical issues/allergies.*
Release/Right to use photos
By submitting this form, I agree to release Anna Banana Arts and Crafts, LLC and any employees of Anna Banana Arts and Crafts, LLC from any injury, illness or medical responsibility. I understand that should an emergency arise, Anna Banana Arts and Crafts, LLC will call 911 first and the parent second. I also give permission for Anna Banana Arts and Crafts to take and use photos of my child/children for promotional and social media purposes. I agree to the terms and cancellation policies of Anna Banana Arts and Crafts.
Please list emergency contact name(s) and phone number(s) here:
Emergency Contact info*
Class Selection & Payment
Fall Session 1
September 8 - October 23

Fall Session 2
October 25 - December 18

Please select your classes below.

Student Information Form