Childrens Registration Form
Child’s name
First
MI
Last
Age
DOB
School
Parent’s name
Siblings
Pets
Home Address
Street
City
Zip
Home Phone
Work/Cell Phone
Email
Mailing list ok?
Yes No
Where did you hear about EAS?
Please select a class
Please Select A Class
Then a date
Date
If you selected a summer workshop please select a time.
AM PM All Day
Emergency contact info:
First Person
Relationship
Contact Number
Second Person
Medical Insurance Carrier:
Policy Number
Phone Number
Does your child have any medical or physical needs?
What is your child’s art experience and interests?
