Art Zone
Name of the child *
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Age *
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Grade *
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School *
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Session # *
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Address *
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Phone Number 1 *
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Phone Number 2 *
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Email *
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Parent/Guardian Name *
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Emergency Contact *
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Medical Insurance Company & Policy *
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Doctor *
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Doctor's Phone Number *
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List Medical Condition(s) *
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Important medications or allergies *
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I understand that instructor is not responsible for any injuries. Parent/guardian Signature: *
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