Registration

Electronic Registration Form

* Indicates required field

Student's Name *

First

Last

Student's Age *

Parent's Name *

First

Last

Cell Number *

Home Number *

Emergency Contact Name *

First

Last

Emergency Contact Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

My Child Is Allergic To: *

I give permission for any quotes, images or likenesses of me or my child and/or our artwork to be used for Santa Monica Art Camp publicity purposes including but not limited to brochures, websites, and videos *

Yes, I agree No, I do not agree

Comments *

I agree to receiving marketing and promotional materials