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Studio B Artworks

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Student Registration

First name*

Last name*

Students Date of birth*

Month

Day

Year

Age*

Grade*

Nickname

If they don't use their full name.

Allergies and reactions of the Student*

Other diagnoses or conditions*

EPIC ID Number

Parent/Guardian name(s)*

Email*

Phone*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Emergancy Contact*

Emergancy Contacts Phone*

Why are you filling this out today?

To have it on file

Because I'm enrolling my child for a group class

I'm trying to get my kid private lessons

Other

I hereby give my consent to use my photographs according to the Terms & Conditions.

I agree to the release of liability

Date

Month

Day

Year

Signature

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Confirm with your initials*

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Studio B Artworks 422 W 4th St, Claremore, Ok 74017

(918)443-7278

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