After School Art Classes with Mrs. Freese

2008-2009 Student Registration Form

Student Name: ____________________________________________________________

Students Teacher: _____________________________________ Grade: _____________

Parent/Guardian Name: _____________________________________________________

Address: ________________________________________________________________

Daytime Phone: ________________________ Evening Phone: _______________________

Cell Phone: __________________________ Email address: ________________________

Emergency Contact: ________________________________________________________

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I agree to provide a snack for my child. My child cannot leave before 3:30 unless prior arrangement has been made. I will pick up my child promptly at 3:30. A child may be dismissed from the class if a parent is late to pick up a child. Parents will be charged accordingly for the teacher’s time. The teacher has a right to dismiss a child for discipline reasons.

Payment is due when student signs up for the art class. If requested, checks for class payment will be held until one week before the class start date.

Please make checks payable to Thoreau PTA.

Please return completed forms into the office or the student’s teacher.

An Art Class will be cancelled if a minimum enrollment of 10 students is not reached.

I have read and understand the above statements and give permission for my child to participate.

Signature: __________________________________________ Date: ________________

Questions? Lynn Kacatin: home: 425-820-8690; email: kacatin@juno.com