Registration Form

Registration Form for Paint Club

To register for a $25 Monthly KIDZ Painting Club please complete all questions.
Parent's or Guardian’s name*

First NameLast Name
Child's name 1*

First NameLast Name
Child's name 2

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Number*

Area CodePhone Number
Work Number*

Area CodePhone Number
School/Organization/ Community Name
School Name*
Teacher's name 1
Teacher's name 2
Child's grade 1
Child's grade 2
Child's date of birth 1*
Child's date of birth 2
MaleFemale
MaleFemale
After careNot in after care
After School monthly Paint club (for example -2nd Friday of every month).E.R. Paint Club Early Release days onlyFine Art Club 3rd grade and upCommunity Art Club at 9898 Lantern St. studio
After School Weekly Art ClubER Paint pARTi(s) Early Release days onlyFine Art Club 3rd grade and upCommunity Art Club at 9898 Lantern St. studio
X-smallSmallMediumLargeX-LargeXX-Large
YesNo
ER Art Club payment options -includes $20 registration (Fees, T-shirt) first month:*
prevnext( X )
New parent w/ one child - ER art club($45.00 for the first month then,$25.00 for each month)

New parent w/ two children - ER art club($78.00 for the first month then,$50.00 for each month)

Returning parent w/ one child - ER art club($33.00 for the first month then,$25.00 for each month)

Returning parent w/ two children - ER art club($66.00 for the first month then,$50.00 for each month)
Signature*
Signature date*
Should be Empty:

Registration Form for Paint Club