AENY University Kid's Saturday Music & Arts Program 2017
Registration Interest Form (You will be contacted once applications are live)
Email address *
Promotional Flyer
Promotional Flyer
Parent/Guardian Name (Last, First) *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Child's Name - 1 (Last, First) *
Including your child's age & current grade level. Please separate with a comma.
Your answer
Child's Name - 2 (Last, First) *
Including your child's age & current grade level. Please separate with a comma.
Your answer
Additional Child's Name - 3 (Last, First)
Your answer
Additional Child's Name - 4 (Last, First)
Your answer
Does your child have any allergies/food allergies? *
Please include if your child has diabetes, uses an asthma pump, or caries the Epi-Pen
Emergency Contact Information: *
Please include Name, Phone #, Email(s), and address. Please separate by a comma.
Your answer
Do give consent for your child to be photographed and participate in video documentation? *
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