Student Enrollment Form Exploring Painting Spring 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 $95 Paid ___
2nd Child $90 Paid ___
3rd Child $85 Paid ___
4th Child $80 Paid ___
Subtotal: ___________
If paid by February 12 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 February 20.