FALL SESSION Registration Please fill out registration form below for the Fall Session at our Encino Studio. Fields marked with an * are required Class InformationClass Title MIXED MEDIA CERAMIC Parent/Child Drawing Month/Session # #1: September #2: October #3: November #4: December #5: January #6: February #7: March #8: April (Spring) #9: May (Spring) #10: June (Spring) Day(s) Monday Tuesday Wednesday Thursday Saturday Sunday Class Time Student's InformationStudent's Name* First Last Student's Birthdate MM slash DD slash YYYY AgeParent's Name #1* First Last Parent's Name #2 First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact InformationHome Phone*Email* Cell Phone #1*Cell Phone #2Emergency Contact (other than parent)* Emergency Contact Phone*General InformationChild's Physician Physician's PhoneChild's School School Grade Level Allergies or Food Restrictions Please share any pertinent information about your childEmergency Treatment*In the event of an emergency and if I or my emergency contacts cannot be reached, I give The Children's Art Studio permission to authorize any treatment deemed necessary by the attending physician. I Agree Payment Method* Check PayPal Account or Credit Card via PayPal EmailThis field is for validation purposes and should be left unchanged.