↑

Art for children with Special Needs Registration Form

Name of the Student

First Name

Last Name

Date of Birth

MM

DD

YYYY

School Attending

Parent's Name

Parent 1

First Name

Last Name

Phone

(###)

###

####

Email Address

Parent's Name

Parent 2

Phone

(###)

###

####

Email Address

Please outline what accommodations your child would need in our classes:

By checking this box you are agreeing to adhere to the CCSA's policies as outlined below.

I Agree