First TIme Registration | Abrakadoodle

Registration Form

Welcome to Abrakadoodle-Art Explorers classes! Please complete the following registration form if you are a first time customer.

How did you hear about us?

Referral Name

Family Information

Family Last Name

Address

Phone

Aditional Info

Emergency Contact Info

Health Insurance Carrier

Contact Information

First name

Last name

Type

Who is Your Employer?

Employer

Employer Phone

Employer Notes

Student Information

Student's First Name

Last Name

Birth Date

Additional Info

Student Email

T-Shirt Size

School

Grade Level

Dismissal Procedures

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies

Medications (Leave blank if NONE)

Primary Doctor

Gender

Dismissal Procedure

Home Room Teacher

Art is fun and messy! Please dress your child in old clothes.

Avaliable Classes

Registration Policy

I've read the above and agree

Recorded Video or Live Zoom Event Policy

Recorded Video or Live Zoom Event

I've read the above and agree

Dismissal Procedures and Authorized to Pick-Up Student Policy

Dismissal Procedures/Transportation Release

I've read the above and agree

Assumption of Risk and Waiver of Liability Policy

Assumption of Risk and Waiver of Liability

I've read the above and agree

Attestation Policy

Attestation

I've read the above and agree

Parent Permission Policy

Parent Permission

I've read the above and agree

Class Schedule List Policy

Class Schedule List

I've read the above and agree

Release of Liability Policy

Release of Liability

I've read the above and agree

Medical Emergency Policy

I agree to all of the above

Payment Information Policy

I agree to all of the above

Materials Policy

I agree to all of the above

Enter your Full Name

Questions or Concerns

Comments

Credit Card Information

Type of card:

Name on the card:

Number:

Expiration date:

Billing Address:

I authorize Abrakadoodle to process my credit card

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Date

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