PAFA fillable registation form 2022:2023

Registration Form Purpose Academy of Fine Arts

Discovery Program Ages 4- 9 (check below)

Pursuit Program Ages 10-18 (check below)

Homeschooler Tutoring program Ages 8-18 (check below)

Who is responsible for monthly tuition?

How will you be paying your tuition?

Annually

Monthly

Check

Card

Pay pal

Step Up for Students

Gardiner

Other

Name

Student First Name Student Last Name

Student Age

DOB

Student Grade Level,

Shirt size

Mothers Name

Father's name

Home Address

City

Zip

Email

example@example.com

Mother's Cell phone

Father's cell phone

Mother's work phone

Father's work phone

Do you consent to receiving text messages?

Emergency Contact Name

Emergency Contact phone

Please list persons other than parents, that have permission to pick up

Name

Phone

Name

Phone

Name

Phone

Security Password

Primary Physician

Health Insurance Carrier

Disabilities

Special Needs

Allergies

Medications

Other Important Information