Form

Little Artist Registration & Payment Form

ALL PROGRAMS ARE LOCATED AT 592 PACIFIC ST BROOKLYN, NY 11217 (718) 857-5437
Registration is a 2-part process:

1. Fill out the form and agree to the disclaimer, then click submit button.
2. You will be prompted to our payment page after you complete registration.

** Enrollment is not guaranteed until you pay in full for your class **
Lets get started!
Are you a returning student? *

YES NO
Has any information changed in the past 6 months? *

YES NO
Please provide us with all the information that has changed *
Student's Information

Please fill out all the information in this section below
Full Name *

First Name Last Name
Grade *
Date of Birth *
Gender
School they attend *
Do you have a sibling who will be joining you during a CBK class? *

YES NO
Sibling's Name

First Name Last Name
Grade
Date of Birth
Gender
School they attend
Please List all the classes siblings are joining together
+ Sibling
**IMPORTANT ** Please be advised that if any siblings are attending different classes you must register them separately
Parent or Guardian Information

Please fill out all the information in this section below
Name *

First Name Last Name
Relationship to Student *
E-mail *
Phone Number *

- Area Code Phone Number
Additional Phone Number

- Area Code Phone Number

Emergency Contact Information

Please fill out all the information in this section below
Name

First Name Last Name
Relationship to Student
E-mail
Phone Number

- Area Code Phone Number
Additional Information

Please fill the information in this section below
Allergies ( please list and explain all allergies; severity, seasonal etc. ) *
Any additional information we should know about your child
** The more information you can provide us regarding any special needs your child may have, the better we can assist your child during class **
Health Care Provider & Policy Number
Little Artist List & Payment

Please select from the following options below

Please Select *

Little Art Class ( Wed | Sept 30 - Jan 20 ) $ 400.00

Quantity

Trial Class $ 30.00

Quantity

Enter coupon

Total $ 0.00

10% Sibling Discount coupon code : S1BLING
PLEASE READ - A copy of all the information provided in the registration form will be sent to the email address you provided under parent & guardian information. After you click the submit button, you will be redirected to the payment page. Registration will only be completed when Disclaimer is read and agreed upon.
I hereby authorize Created By Kids LLC. to take photographs, videos and images of my child during their time in our classes. I give Created By Kids permission to use my child's photo for their website, group photos, media and any form of marketing material used for Created By Kids.
Photo Authorization *

Agree Disagree
Disclaimer:

Participation in Created by Kids programs will involve children using tools and materials in a supervised but active setting. By registering, making payment to, and/or participating in Created By Kids classes, the participant’s Parent/Guardian understands and accepts the risks inherent in their child’s involvement with the program and will hereby release Created By Kids LLC, its owners, and employees from any liability or claim of any kind for damages and/or injuries that occurred as a result of the students or parents involvement in programs provided by Created By Kids LLC. The Parent/Guardian hereby accepts all risks involved with their child’s participation in creating art in a supervised workshop setting.
Please Select *

Agree Disagree
Registration will only be completed when Disclaimer is read and agreed upon. If you have any questions please contact us at rene@createdbykidsnyc.com. Thank you!
You are Almost finished...

After you click the submit button you will be redirected to the PAYPAL payment page.
Should be Empty:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Little Artist Registration & Payment Form

Lets get started!

Student's Information

Parent or Guardian Information

Emergency Contact Information

Additional Information

Little Artist List & Payment