Easter Registration Form

ALABASTER ARTWORK
Part Art Studio-Part Kids Place
226 West 13th Avenue Covington LA 70433
(3 blocks from St. Tammany Parish Hospital)
985/502-7250
Email alabasterartwork@yahoo.com www.alabasterartwork.com
Easter Camp Registration Form for April 2nd-6th
Child’s name: ______________________________
Phone : ______________________
Address: _____________________________
City /Zip: ________________________
Grade currently: _____ School: ___________________ Age:_____ Male or Female
Email address: _________________________________
Date of Birth:_______________
List any previous art classes taken & age/grade of child: ___________________________
Cont.__________________________________________________________________
I am registering for April 2nd-6th: 9am-12noon (drop off starts @8:40am)
How did you hear about Alabaster? ___________________________________________
Parent’s name____________________________
Cell phone: ______________________
Alternate contact in case of emergency: ________________________________________
Relationship: _____________________
Phone: _________________________________
List any allergies or disabilities your child may have___________________________________________________________________________________________________________________________________________
Child lives with ___ both parents ___ father ___ mother ___ guardian: _______________
If parents are separated or divorced, who has legal custody?_________________________
Name of person(s) other than parent allowed to pick up child(ren):
_______________________________________________________________________
PARENT’S AGREEMENT
I agree to all of the terms given in this agreement and I understand it is a legal document. I give permission to Alabaster Artwork and Elizabeth Winters serving as Director to care for my child during the time he/she is on premises and to secure emergency medical care for my child if Alabaster Artwork is unable to reach me.
Child’s Doctor: ____________________ Phone: ________________________
Parent’s Signature: ________________________________
Date: ____________