After School Program Enrollment Form

After School

REGISTRO DE UN NUEVO NINO
Foundation for New American Art in partnership with New State Council of the Arts and Hudson River Housing

is pleased to offer an exciting After School Program for children ages 8-12.

We offer drawing, dancing, singing, music and acting training,

Tuesday and Thursday from 3:30 - 5:30. This program is free.

Please complete and submit one form per student being enrolled in the After School Program.
Child's Name = Nombre de Nino*

First NameLast Name = Nombre Apellido
Parent's Phone Number = Teléfono*

Area CodePhone Number
Email*
Parent/Caregiver Name = Nobre de Madre/Padre/Abuella/Hermanos*

First NameLast Name
Grade (2024)*

Grade 3Grade 4Grade 5Grade 6Grade 7
En Español:

___________________________________________

Persona responsable (si es diferente que la madre)

______________________________________

Who do we notify in case of emergency?

Persona a notificar en caso de emergencia:

____________________________________

First Name_Last Name (Nombre_Apellido)

___________________________________

Nombre________________________

Numbero de teléfono_________________________
Please note any known allergies:
Please specify each person, including the name of parents, who has permission to pick up your child at 5:30 from the After School Program.
Authorized Person 1:

First NameLast Name
Phone Number 1:

Area CodePhone Number
Authorized Person 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
Authorized Person 3:

First NameLast Name
Phone Number 3:

Area CodePhone Number
Authorized Person 4:

First NameLast Name
Phone Number 4:

Area CodePhone Number
Statement of Policy
I have read and understand the Statement of Policy contained here.*

Agree
I give Foundation for New American Art permission to take some photos of my child for fundraising reasons, and for the live stream TV show The Color Wheel*

Agree
Should be Empty:

After School

Statement of Policy