Art Class
Enrollment Form

Students Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Consent *

I give permission for the child named on this form to attend art classes at 1 Francis Road, North Avoca, and in doing so release the owner from any liability arising from such participation. I give permission for the organiser to call for medical assistance for my child in the case of an emergency, if they have tried and unable to contact me first.

Yes

No