Creative Arts Academy

Student Registration Form

FIRST NAME

LAST NAME

DATE OF BIRTH

AGE

GRADE

CHOOSE PROGRAM OF INTEREST DANCEGYMNASTICSPRESCHOOL

ADDRESS

CITY

STATE

ZIP

HOME PHONE (xxx-xxx-xxxx)

CELL PHONE

MOTHER/GUARDIAN NAME

MOTHER'S EMPLOYER

MOTHER"S WORK PHONE

FATHER/GUARDIAN NAME

FATHER'S EMPLOYER

FATHER'S WORK PHONE

*Registration will be completed at the office