sunflower
art studios
P 845.419.5219
After School Art Class Registration Form
Please fill out form, include payment, and return in a sealed envelope to: Sunflower Art Studios, Inc.
120 Main Street
Gardiner, NY 12525
**Please write very legibly**
Child’s Name: ____________________________________________________________________________________
First
Last
Child’s Current Grade in School: _______________
Child’s School: __________________________________
Does your child have any food or skin allergies? ________________________________________________________
Parent Name: ____________________________________________________________________________________
First
Last
Parent Mobile Phone #: _____________ Parent Contact Email Address: ____________________________________
Your best email address for messages & updates
Home Address: ___________________________________________________________________________________
Street # and Name
City
Zip Code
Emergency Contact Name & Phone #: ________________________________________________________________
Someone other than yourself in case you cannot be reached
*Media Approval – Sunflower Art Studios, Inc. takes pictures of participants and their artwork in various activities for use in the marketing and
promotion of our programs. Sometimes, pictures will be uploaded to our website, our Facebook Page or our Instagram Account. Full names
will never be used and pictures will never be tagged to ensure anonymity. I hereby grant permission to Sunflower Art Studios to use the
pictures of me and/or my child(ren) for this stated purpose. (Please check a box below)
Yes, pictures are OK with me
No, pictures are not OK
WINTER/SPRING SESSION (Please check which class you are registering for below)
Kinders, 1st and 2nd Graders (Tuesdays 4:20pm – 6:00pm)
$150 for 5 week session
$250 for 10 week session
Advanced Workshop – 4th, 5th and 6th Graders
(Wednesdays 4:09pm – 6:00pm)
$150 for 5 week session
$250 for 10 week session
3rd, 4th and 5th Graders (Thursdays 4:09pm – 6:00pm)
$150 for 5 week session
$250 for 10 week session
* Your child’s spot in class is not reserved until this form and payment have been received. Only cash and checks are accepted.
(Please make checks out to Sunflower Art Studios, Inc.) Once we have received your registration, you will receive an email
confirmation (to the email address listed above) confirming your child’s registration in the class and payment received. Please
allow 2-3 business days for processing.
* If your child is not attending the entire session, please send a private email to [email protected] for prorated cost.
Notes: ___________________________________________________________________________________________________
_________________________________________________________________________________________________________