Thank you for enrolling in the Arts Clubhouse for Kids Summer Program! Please fill out the following form details to complete your registration. Your registration confirms that your child is registered for each class of this 6-day program.

Parent’s First Name *

Parent’s Last Name *

Parent’s Phone Number *

Parent’s Email Address *

Child's First Name *

Child's Last Name *

Child's Age *

Child's Grade *

Your Child is a *

Your child's t-shirt size *

Your Child's Birthday *

Arts Clubhouse For Kids (Summer) - AZ Class Selection

What school does your child attend? *

Emergency Contact Phone Number *

Emergency Contact Relation to Student *

Emergency Contact Full Name *

Parent/Guardian Street Address *

Parent/Guardian City *

Parent/Guardian State *

Parent/Guardian Postal Code *

Parent Signature

Clear

Photo Release *

Photographs and videos in which my child appears may be used by Epitome of Soul, Inc. Programs for publicity purposes such as advertisements on the Epitome of Soul website, in publications and on social media.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.