Heartland Student Registration
Please complete this form for each student. Classes are 90 minutes each. More details can be found on our website: esterobayartandcraft.com. Thank you for registering with our program!
Student's Name:
*
First Name
Last Name
Student's grade:
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Primary adult contact name:
*
First Name
Last Name
Primary adult contact email:
*
example@example.com
Primary adult contact phone:
*
Please enter a valid phone number.
Emergency contact (not the primary listed above):
*
First Name
Last Name
Emergency contact phone:
*
Please enter a valid phone number.
Which class(es) are you registering your student for:
*
Mondays @ 10:30: Exploring Mediums & Methods (6th-12th)
Mondays @ 1:00: Visual Expression w/ 2D arts (1st-5th)
Tuesdays @ 1:00 : Crochet & Knit for Life (6th-12th)
Wednesdays @ 9:30: Exploring Mediums & Methods (1st-5th)
Wednesdays @ 1:00: Young Artist Collective (6th-12th)
Thursdays @ 11:00: Hand Sewing - Skills & Techniques (3rd-6th)
Thursdays @ 1:00: Hand Sewing - Skills & Techniques (7th-12th)
Fridays @ 9:30: Exploring Mediums & Methods (1st-5th)
Any notes are comments:
Submit
Should be Empty: