Assyrian Cultural Foundation

Fields marked with * are required

Student's Full Name *

Date of Birth *

01/01/2017

Gender *

Preferred Day *

Our classes are offered on Tuesdays and Saturdays. Please indicate which day of the week is preferable.

Street Address *

APT/UNIT

City/Town *

Zip

Current Grade *

Select a T-Shirt Size *

Please list any medical information that needs to be on file, including allergies:

Has your child studied art in school (as an elective or special course):

Please select the number of years your child has participated in any art program outside of their traditional schooling:

If your child has formally studied art in the past, please indicate where:

Parent/Guardian Full Name

Primary Phone Number

Secondary Phone Number

Parent/Guardian Email Address *

Method of Contact

Emergency Contact Name #1

Phone Number

Relationship

Emergency Contact Name #2

Phone Number

Relationship

Acknowledgement *

I, the undersigned parent/guardian of (said minor), acknowledge that I have received, read, understand, and agree to abide by all AUAF student registration and attendance policies and procedures. I give permission for said minor to participate in the AUAF art program. I understand that by signing this authorization, I will not hold AUAF liable for any injuries incurred while participating in program activities in which I have enrolled said minor. I understand that AUAF is not responsible for any payments incurred due to medical care for said injuries.

Music: Student Application