King Arts Complex Registration Form
Registration form for Youth Programs, 2019-2020
*Registration fee for academies and camps are $25 per child*
Email address *
Please choose one: *
Will you need financial assistance? *
Have you or your child participated in this program before?
Participants Name *
Your answer
Address (City, State, Zip Code) *
Your answer
Participants Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Phone Number *
Your answer
Emergency Contact Information
Must be a parent or guardian if under 18 years of age
Name *
Your answer
Relationship *
Your answer
Address (if different from above, if the same type"Same") *
Your answer
Phone number *
Your answer
Phone number 2
Your answer
Email Address (if same as above, enter "same") *
Your answer
If primary Emergency Contact is unavailable, please provide a secondary contact
Name Relationship Cell Phone #2 *
Your answer
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