Student Enrollment Form  Exploring Painting Fall 2024

Child Name(s) (include M or F) ______________________________________________________________________________   

Age(s) _________________ Grade(s) _________________ Address _________________________________________________

Cell  Phone 1 ______________________________________Parent’s Names _________________________________________

Cell phone 2______________________________________ Email address ___________________________________________ 

Class Location/Time/Day of Week___________________________________________

I give permission for my child’s photos to be used on NewCreations FB Page, website or other platforms. YES____NO____                      

 I give permission for my child to be treated in case of emergency at Mrs.Seitz’ discretion until I can be contacted. YES____ NO____

Parent Signature __________________________________________________________

Tuition:  1st Child   $70 Paid  ___ 

                   2nd Child  $70 Paid ___

                   3rd Child  $70 Paid ___ 

                   4th Child  $70 Paid  ___ 

                   Subtotal: ___________

If paid by September 1 subtract $5 on total cost!

                 Total Cost: $ _______________  Check Number: ___________

Please send enrollment forms and payment to:  P.O. Box 222, Plymouth, IN 46563.

Checks should be made out to Gloria Seitz. Please send in payment by September 6.