Parent First and Last Name *

First Name

Last Name

Parent Phone *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

This is the person who will be contacted if there is an issue during class (or last minute notice just before class).

First Name

Last Name

Emergency Contact Phone *

Used for last minute class changes/cancellation text messages or to contact if there is a problem during class.

(###)

###

####

Student First and Last Name *

First Name

Last Name

Student Birthday *

MM

DD

YYYY

Please Acknowledge Each of the Following *

I understand that art can be messy. Even though students wear aprons, it is not guaranteed something will not get on clothes that is permanent.

I understand that photos and videos may be taken and that if I do not want my images shared, I must email info@rosellefa.com.

I understand that my autopayment will be processed on the first of each month.

I understand that to stop lessons I must notify you by the 25th of the month to prevent being billed for the following month.

I understand that credit will not be given for missed lessons unless you notify us at least 2 weeks in advance. Missed lessons may or may not be able to be made up during another time slot or supplies sent home, but this is not always possible.

I understand that I have 60 days to pick up any artwork or art supplies I left behind (or at least make arrangements within those 60 days).