Registration - Keren Drawing and painting school

Name of the Student (first name, middle name and last name) * *

Father's Name * *

Mother's Name * *

Name of emergency contact person * *

Email of parents or guardian * *

User Password *

Confirm Password *

Phone Number of parents or guardian * *

Residential address of the student/parents *

Residential address of emergency contact person * *

Any allergies the student has that the teacher need to be aware of *

Any medical condition of the student that the teacher need to be aware of *

Alternative phone number *

Date of Birth * *

Start date *

Grade level ( Course of preference ) *

Program of Preference

Method of learning * *

Convenient Day and time (Mountain time Zone) * *

Signature of a parent or guardian (Writing your name here will be considered signature) *

Date consent form signed