Art Mix: Houston, Texas: Registration Form

Registration Form:

Semester registering for:	Winter 2008	Spring 2008
	Summer Camp 2008	Special Needs Camp 2008

Child's Last Name			Child's First Name
Age				Date of Birth
Address
City	State				Zip
Parent/Guardian's Name
Home Phone		Work Phone
Cell Phone			Email Address
Contact in Case of Emergency
Does Your Child Have Any Allergies?
Who will be bringing and picking up your child from ArtMix? (Note: Only persons listed on the form will be permitted to transport your child).

Please tell us about your child:
(Fields recommended but not required)

Birthday	Grade in School
Name of Child's School
What activities interest your child?
Does your child have any special interests, hobbies, and/or collections?
What activities does your child prefer at school (math, reading, science, art, sports, other...)?
What learning activities does your child avoid and/or find challenging?
What art activities does your child currently enjoy?
What do you hope your child will gain coming to Art Mix?
Please add additional information that will help our teachers provide the most rewarding learning experiences for your child at Art Mix.

Class Selection:

Please select your 1st, 2nd, and 3rd choice of class day and time below. Classes are offered Monday - Friday and meet once per week for 90 minutes. In the boxes below, type the day(s) of the week you would like to register for. You can type in more than one day.

Please select your method of payment:

Check

Visa

MasterCard

If you would prefer to pay by check, please bring payment with you to class, or mail to:
Art Mix Learning Center, 3701 W. Alabama, Suite 250, Houston, Texas 77027.

If you would prefer to print the registration from and fill it out in writing, use the link below:

Download your registration documents in Adobe PDF format here.

Art Mix Creative Learning Center, 3701 W. Alabama, Suite 250, Houston, Texas 77027
Phone: 713.552.9028, Fax: 713.552.9780
contact@artmixlearning.com