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Rizkallah Kids Art Courses Art Academy 2017/2018
Registration Form
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* Indicates required question
*
Your answer
Child's last name
*
Your answer
Gender
*
Female
Male
Age
*
Choose
3 years old - 4 years and 11 months old
5 years old - 6 years and 11 months old
7 years old - 12 years and 11 months old
Birth Date
*
Month/Day/Year
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Home address:
Your answer
Grade in September, 2017:
Your answer
Nursery/School Name:
Your answer
Spoken Languages:
*
English
Arabic
French
German
Other:
Required
Allergies? If yes, please specify
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Mother's details
Mother's first name:
*
Your answer
Mother's last name
*
Your answer
Mother's mobile number:
*
Your answer
Mother's email address:
*
Your answer
Father's details:
Father's full name:
Your answer
Father's mobile number:
Your answer
Father's email address:
Your answer
Emergency Contacts
Please provide us with one additional contact to contact in case of an emergency
Full name:
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Mobile number:
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Pick up details
Who will pick up the child? If other, please provide their name as on their personal ID and their relationship to your child
*
Mother
Father
Other
Required
If other, please provide their name as on their personal ID
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Their relationship to your child :
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Their phone number:
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Enrolled in:
Course Enrolment (September 24th – December 10th)
*
1- Art Cocoon: Ages 3 – 4 years and 11 months old
2- Art-venture: Ages 5 – 6 years and 11 months old
3- Art Studio: Ages 7 – 12 years and 11 months old
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