Student One
Full name: (required)

Date of birth (required)

Health conditions or allergies:

Student Two (if applicable)
Full name:

Date of birth

Health conditions or allergies:

Student Three (if applicable)
Full name:

Date of birth

Health conditions or allergies:

Parent / Caregiver
Full name: (required)

Phone: (required)

Email: (required)

Emergency Contact
Full name: (required)

Phone: (required)

Workshop Date Selection
Please select all dates that are suitable for you. This gives us some flexibility to fit your child into our holiday workshop.
16 Sep17 Sep18 Sep19 Sep20 Sep

I give permission for my child’s picture to be used in any advertising material for LITTLE ART LAB. (optional)

I give permission for my child’s artwork to be used in any advertising material for LITTLE ART LAB. (optional)

I have read and agreed with the terms and conditions.