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FALL 2017 After School Arts Program Registration
Please complete the form below to register your child for an ASAP class. If you have questions, please contact Ann Fields Monical at
Email address
Please complete a separate form for each participating student.
Student First Name
Your answer
Student Last Name
Your answer
Student Grade Level
Your answer
Student Street Address
e.g. 612 Picasso Drive, Apartment 6
Your answer
City, State, ZIP
e.g. Lafayette, IN 47905
Your answer
Student's School
Your answer
Student's sex
Student's primary race
Is the student's ethnicity Hispanic/Latin@?
Does the student qualify for a free/reduced school lunch or textbook program?
Any health conditions or other notes the Tippecanoe Arts Federation should know about the student:
Your answer
Please complete the following fields with your information.
Parent/Guardian First Name
Your answer
Parent/Guardian Last Name
Your answer
Parent/Guardian Phone Number
Your answer
Parent/Guardian Email Address
Your answer
Best contact method for Parent/Guardian
Additional emergency contact name
Your answer
Emergency contact's relation to student
i.e. "Grandfather," "Family friend," etc.
Your answer
Emergency contact phone number
Your answer
Please select all the classes in which the student wishes to enroll:
Please complete the captcha before submitting the form.
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