the art room nyc, inc.

REGISTRATION FORM

REGISTRATION FORM

student name

First Name

Last Name

gender

age

birth date

school and grade

day/time requested

parent/guardian name

email address

phone (best)

(###)

###

####

home address

signature of parent or guardian and date signed

regarding permission to use photos

how did you hear about the art room?

if Other, please tell us: here: