STUDIO GO/ REGISTRATION FORM

                                                        August 2 - 6, 2009,  6:00 to 8:30 PM

     Child's Name     

Date of Birth    Grade Completed    Age 

          Parent/Guardian      

          Address  

          Home Phone  

          Cell Phone     

           E-mail           

  Emergency contact name & number

  Special needs/allergies

  Is there a special friend your child would like to be with?