Registration Form 2018-19
Email address *
Student's Name *
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Date of Birth *
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Guardian's Name *
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Address *
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City *
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Zipcode *
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Daytime Phone Number *
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Emergency Contact *
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Emergency Contact Number *
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Pediatrician *
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Pediatrician's Address *
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Pediatrician's Telephone Number *
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Please List Any Allergies *
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Studio Location *
Please list the class(es) your child will be taking: *
Your answer
Release & Waiver
The undersigned hereby waives and releases Sherri Hellman and the Creative Arts Studio from all claims as to any and all injuries that may incur or sustain at the Creative Arts Studio.
Student's Name *
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Parent's Name *
Your answer
Address, City, State, Zip Code *
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Telephone *
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Signature (please print full name) *
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Date *
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Please Check One: *
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Guardian Signature (please print full name) *
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Date *
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