Creative Arts Studio – Fall Placement Registration

Please fill out the following form completely so that we can better understand your needs and respond accurately. Upon receiving this information, we will review your selections and send an invoice indicating the total cost for the program based upon your provided information.

A per family registration fee of $100 (for new registrations) or $25 (for re-registrations) will be included on the invoice as well.

IMPORTANT: If you do not provide a valid e-mail address, this form will NOT submit your information to us, even though you may receive the confirmation page. Acceptance/receipt of this form and registration fee is NOT a guarantee that the days requested are available. We will make every effort to accommodate your request and we will notify you prior to proceeding if we are unable to place your child(ren) in a program on the days requested by you.

Thank you.

All contact information in this first section below is required.

Parent's Name:
Home Address:
City / State / Zip:	Select one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Home Phone:
Cell/Work Phone:
E-mail Address:
Below, please select/check the days of the week that you wish to reserve, along with the estimated drop-off and pick-up times for those days. PLEASE NOTE THE FOLLOWING MINIMUM ENROLLMENT REQUIREMENTS       --> LOWER SCHOOL – must be at least 2 days per week       --> UPPER SCHOOL – must be at least 3 days per week               (Please refer to our Programs page for program details)
Child's Name:
Date of Birth:
Mon. Tues. Wed. Thurs. Fri. Drop-off: Pick-up:
Child's Name:
Date of Birth:
Mon. Tues. Wed. Thurs. Fri. Drop-off: Pick-up:
Questions/Comments?