Studio Artemis
Studio Artemis
Sculpture - Ceramics - Pottery Wheels - Tuition - Art Therapy
Sculpture - Ceramics - Pottery Wheels - Tuition - Art Therapy
Enrolment Form
Studio Artemis
Enrolment Form Child 2021
Class……………………………………… Day 1/Time…………………
Class……………………………………… Day 2/Time……………………
Child Name……………………………................................................
Child Name……………………………................................................
Parent Name…………………................................................ (if under 18)
Age………….. School Attended ..............................................(if under 18)
Address………………………………………………………………………
…………………………………………………………….Postcode………
Tel: Home…………………Mobile……………………Work………….......
Email………………………………………………………………………….
Emergency Contact
Name…………………………….................................
Emergency
Tel……………….........................................................................
Asthma/Allergies to Nuts Dogs or Other: (circle)
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Epi Pen required yes / no
Disabilities
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How did you hear about us?
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I wish to pay by: Cash Credit Card Visa MasterCard
Amount: $..................... Paid in Full by Cash Direct Deposit Credit Card Gift Voucher
Card Number .... …. …. …./…. …. …. …./…. …. …. …./…. …. …. ….
Expiry Date …. …./…. …. Cardholders Name………………………….
Cardholders Signature………………………...................Date………….
Office Use Only:
Receipt Number…………………………….
Date…………………………….