Spectrum Arts Fall 2017 Application
Spectrum Arts Fall session begins September 18th. Please fill out the form and one of our staff will follow up to answer questions and give further details.
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Student First Name *
Student Last Name *
Student Age *
Student Birthday *
Student Identifies as: *
Please check all that apply
Required
Student Cell Phone
If N/A leave blank.
Student Email
Student emails will only be used by instructors to share class updates and materials.
Student Address, City, State, Zip Code *
Art Program 1st Choice *
Required
Art Program 2nd Choice
Guardian 1 Name *
Guardian 1 Phone Number *
If you have more than one relevant phone number (Cell, work, etc.) please list them here
Guardian 1 Email *
Guardian 1 Address *
Guardian 2 Name
Guardian 2 Phone number
If you have more than one relevant phone number (Cell, work, etc.) please list them here
Guardian 2 Email
Guardian 2 Address *
Does this student have any health concerns we should be aware of? *
Does this student have any known allergies or dietary restrictions? *
Will lack of transportation block your student from coming to Spectrum Arts Programs? *
Is there anything else we should know about this student?
Emergency Contact Name *
If we are not able to get a hold of either Guardian 1 or Guardian 2, who should we contact?
Relationship to Student
Emergency Contact Phone Number *
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