Academy of Fine Arts Registration Date_______________________________________
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Student’s first name Last name
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Mother’s name Father’s name Home phone
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street address City State Zip
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Mother’s work phone Cell phone E-mail address
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Father’s work phone Cell phone E-mail address
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Emergency contact name Relationship Phone
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Student’s grade in fall Age Sex Birthday School
How did you learn about the Academy? __________________________________________________________________________
Class(es) enrolling in:
1. _____________________________________________________________________________________________________________
Class/Instrument Teacher Day/Dates Start & End Times Tuition
2. _____________________________________________________________________________________________________________
Class/Instrument Teacher Day/Dates Start & End Times Tuition
_________ I have read, understand, and agree to the Policies & Procedures of the AFA.
_________ AFA may use my child’s picture for promotional purposes (please check).
Make check payable to Academy of Fine Arts and mail to: 4519 Providence Road, Charlotte, NC 28226. Please use a separate form for each student.
For more information, call 704-366-0199 or visit www.afacharlotte.org
1-9-2010
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