Register — South Avenue Arts

Please provide the following information:

Parent or guardian

First Name

Last Name

Email Address

Daytime phone

(###)

###

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Cell phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency contact

First Name

Last Name

Contact's phone

(###)

###

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Child 1

First Name

Last Name

Age

Child 2

First Name

Last Name

Age

Allergies

Special instructions

(Link to payment)