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enrollment form

Student Information Form PDF… CLICK HERE

This form must be received by color wheel studio prior to the beginning of your child’s first class. Feel free to bring this completed form with you to the studio.

Student’s Information

Child’s name

(last) ­­­­­­___________________________________________________________

(first) ___________________________________________________________

Birth Date ________________________________________________________

What school does your child attend?______________________________________

What grade? ______________________________________________________

You are registered for what color wheel studio class?

________________________________________________________________

Emergency Information

Parents’ names

_________________________________________________________________

_________________________________________________________________

Home address

_________________________________________________________________

City____________________________________ Zip _______________________

Home phone _______________________________________________________

Cell phone _________________________________________________________

Email address

_________________________________________________________________

In addition to above named parent(s), who may pick up your child from color wheel studio?

Name: ____________________________________________________________

Relationship: _______________________________________________________

Name: ____________________________________________________________

Relationship: _______________________________________________________

Please let us know if someone other than you will be picking up your child from color wheel studio.

Emergency contact (other than parent):

Emergency phone ____________________________________________________

Pediatrician name ____________________________________________________

Phone_____________________________________________________________

Does your child have any medical conditions of which color wheel studio should be aware?

If so, please explain:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Parent/Guardian Signature

_________________________________________________________________

date  _____________________________________________________________

How did you hear about color wheel studio?

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Would you like to receive emails from us?____________________________________

Please rest assured, color wheel studio and its staff will keep your information private.

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