Student Name *

First Name

Last Name

Birthday

(if under 18)

MM

DD

YYYY

Sibling Name (if applicable)

For additional siblings, please see the front office.

First Name

Last Name

Sibling Birthday

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Address

If different from above.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Emergency Contact Alternate Phone

(###)

###

####

Interested in:

Check all that apply

Art Classes

Music Lessons

Junior Renaissance (Ages 3-5)

If you have already scheduled a trial, please input the date here:

MM

DD

YYYY

How did you hear about us?

(Check any that apply)

Online Search

Drive By

Facebook

Instagram

Twitter

Yelp

Groupon

Print Media

Homeschool Program/Charter School (Please specify in the space below)

Outside Event

Word of Mouth (Please specify who referred you to us in the space below)

Acknowledgement of Policies *

Please note that the Center requires 30-day emailed notice to cancel any program (sent to office@camcenter.org). If you haven't already, please take a moment to review the Creative Arts & Music Center Policies at http://camcenter.com/policies

I have read and acknowledge the Creative Arts & Music Center policies - regarding Tuition, Make-Ups, and Social Media