Students Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Parents Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact Name & Number
*
Session
*
Please ensure to select the age group your child belongs to at the time of enrollment. Unfortunately, we are not accepting children under the age of 5 at this time.
Has your child previously been enrolled in Artsy Kids?
*
Race
*
Ethnicity
*
Hispanic
Non-Hispanic
Indigenous
Prefer not to say
Gender
*
Female
Male
Prefer not to say
Other
Has your child been diagnosed with a developmental disability? If so, please provide any relevant details.
Does your child have any health related concerns we should know about? (allergies, asthma, etc)
This program places a strong emphasis on promoting social emotional development and mental well-being. We have access to a child clinical psychologist and clinical art therapist. Would you be interested in speaking to them at some point throughout the program?
*
How did you hear about our program?
*
*
