Spiral Art Studio

NGB - Studio #1 12 Cataraqui Street Kingston, ON K7K 1Z7 h.613.777.5188 c.343.333.1789 heatherkushum@gmail.com www.spiral-art-studio.ca

Registration Form

Parent’s name: Student’s name: Student’s age: Address: Home telephone: Work telephone: Cell phone: Email:

Health issues:

Allergies (List all known allergies to food, medicines, and art materials such as latex gloves):

How did you hear about (name of business)?

Regular Class Registration: Please type in preferred class or workshop

Seasonal Camp Registration: Preferred weeks of attendance:

[ ] Half day [ ] Full day

$ for half-day weeks x number of weeks = Total $ $ for full-day weeks x number of weeks = Total $

Spiral Art Studio

Payment: [ ] Check [ ] Cash (option will come soon to pay Credit card (type of card; e.g., Visa, MasterCard) )