Summer School Registration 2016

Parent/Guardian Information

Parent/Guardian Name

First Name

Last Name

Parent/Guardian relationship

Mother/Father/Friend

Parent/Guardian Email

Parent/Guardian Cell Number

(###)

###

####

Parent/Guardian Home Number

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

STUDENT INFORMATION

Student Name

First Name

Last Name

School

Grade

As of April 2016

Art teacher

Why would you like to attend this program?

Which high schools are you applying to?

How did you hear about the program?

Example: friend, family member, teacher, mailing list, social media