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Club MSA: Arts After School
Ready to join Club MSA? Have your parent/guardian complete this online permission form or print one out for them to sign and bring it with you to your first class!
Printable PDF:
https://drive.google.com/file/d/1j1ZbQ7LfKGMOD_8P4NVLtWSTIQXotkoW/view?usp=sharing
Please contact MSA at 207-879-4629 or
kemal@mayostreetarts.org
with any questions.
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* Indicates required question
Email
*
Your email
Student's Name
*
Your answer
School
*
Your answer
Grade
*
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Parent/Guardian's First Name
*
Your answer
Parent/Guardian's Last Name
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zipcode
*
Your answer
Cell Phone
*
Your answer
Work Phone
Your answer
Emergency Contact's Name
*
Your answer
Emergency Contact's Relationship to Student
*
Your answer
Emergency Contact's Cell Phone
*
Your answer
What languages do you speak at home?
Your answer
Please list any physical or behavioral limitations/restrictions, allergies, medications, and/or special needs such as interpretation.
Your answer
Transportation
*
Parent/Guardian Pick-up
I give my student permission to WALK home
Required
Who is authorized to pick-up your student?
Your answer
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