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 NameStudent 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
Should be Empty: