E-learners PLUS Young Artist Club (Registration & Payment)

Student Information

Parent/Guardian Information

Emergency Contact Information

Informed Consent & Acknowledgement

Following the pronouncements above I hereby declare the following:

Medical Release & Authorization

Signature

BY ACKNOWLEDGING AND SIGNING ABOVE, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Payment

If you only need care for certain days of the week, please check the box on the days your child will attend.
$ 0.00