MOCHA Sensory Art at Joaquin Miller Registration Form
This is the registration form for the MOCHA Sensory Art after school enrichment class. Class will be held Thursdays from 3:10-4:10 p.m. for K-2 on September 21-December 14, 2017. Please answer all of the following questions. Space is limited and will be available on a first come, first serve basis.
Email address *
Student's Name: *
Your answer
Student's Grade: *
Your answer
Classroom of Origin and Teacher's Name: *
Your answer
Parent/Guardian's name and contact information. Please include phone number and email: *
Your answer
Emergency Contact. Please include name and phone number: *
Your answer
I authorize my child to be released to the following individuals (list name, relationship, and phone number): *
Your answer
Where will the student go after MOCHA Art class? *
Does the student have any allergies?
Your answer
Any special needs/considerations?
Your answer
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