Fall Registration Form
Questions? Call 214.750.7118
Kid Art, 3407 Milton Ave., Dallas TX, 75202.

Please PRINT Clearly! Thank You.

Name of Student: _____________________________________________________________

Male ... Female .. Age _________ DOB____/____/____ Grade in School: ______________

Parent/Guardian: _____________________________________________________________

Address: ____________________________________________________Zip:_____________

Home Phone: _______________ Wk Phone: __________________Cell: __________________

E-mail: ________________________@___________________

Emergency Contact Name: ________________________________ Phone:________________

Emergency Contact Name: ________________________________ Phone:________________

Class Day & Time: 1. _________________________ 2. _______________________________

Alternate Person Authorized to Pick Up the Child (other than the parent)

____________________________________________________________________________

I hereby covenant and contract to release and indemnify, save, and hold harmless, Kid Art, as well as its officers, agents, and employees from any and all claims of whatsoever nature or type resulting from any act or commission, omission, or negligence of Kid Art and/or its employees or agents arising from activities under or related to the enrollment of my child for which a claim, demand, suit or other action may be made or brought by any person or other entity against Kid Art.

Parent Signature: _______________________________________________________

Date: ____________________, 2007

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