Prairie Music & Arts: Art Registration Form - 2019-2020
Use this registration form for Art Class Registration
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Last Name of Student *
First Name of Student *
Home Phone *
Parent #1 First & Last Name *
Parent #1 Phone (Cell Phone) *
Parent #2 First & Last Name
Parent #2 Phone (Cell Phone)
Email Address - Please list all addresses you check most frequently in order to maintain regular communication with PMA. *
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's Age/Grade in Fall *
School Attending
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