ABK002 Online Registration

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Welcome to Abrakadoodle Art!! After-school student classes: A one-time yearly registration fee of $25 will be posted to your account upon registration. Please allow 48 hours for fees and discounts to be manually adjusted. *Reminder to select a class for all siblings registered at the same time. Registering for Art Splash or Girls' night for Adults: No added Registration or Material fee will be charged! Abrakadoodle Summer Art Camps: fees include all registration, materials and instruction

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Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

PROMO CODE

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level

Dismissal Type from Abrakadoodle: Parent Pick-Up / Extended Day / Goodtimes

Disabilities (Leave blank if NONE)

Special Needs (Write NONE if not applicable)*

Allergies (Write NONE if not applicable)*

Post Class Dismissal Procedure*

Authorized to Pick-Up Student*

Student&Art Photo Permission*

Thank you for choosing Abrakadoodle Art Education Classes or Camps. If you provided an email address, you should receive a confirmation email. The next time you register for a class, you don't need to fill in your personal information again. To view your account online, please visit our website and click on the "Customer Log In" button. Please allow 48 hours for fees and discounts to be manually adjusted. Your payment will not be processed until all fees are corrected.

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level

Dismissal Type from Abrakadoodle: Parent Pick-Up / Extended Day / Goodtimes

Disabilities (Leave blank if NONE)

Special Needs (Write NONE if not applicable)*

Allergies (Write NONE if not applicable)*

Post Class Dismissal Procedure*

Authorized to Pick-Up Student*

Student&Art Photo Permission*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level

Dismissal Type from Abrakadoodle: Parent Pick-Up / Extended Day / Goodtimes

Disabilities (Leave blank if NONE)

Special Needs (Write NONE if not applicable)*

Allergies (Write NONE if not applicable)*

Post Class Dismissal Procedure*

Authorized to Pick-Up Student*

Student&Art Photo Permission*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level

Dismissal Type from Abrakadoodle: Parent Pick-Up / Extended Day / Goodtimes

Disabilities (Leave blank if NONE)

Special Needs (Write NONE if not applicable)*

Allergies (Write NONE if not applicable)*

Post Class Dismissal Procedure*

Authorized to Pick-Up Student*

Student&Art Photo Permission*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

School

Grade Level

Dismissal Type from Abrakadoodle: Parent Pick-Up / Extended Day / Goodtimes

Disabilities (Leave blank if NONE)

Special Needs (Write NONE if not applicable)*

Allergies (Write NONE if not applicable)*

Post Class Dismissal Procedure*

Authorized to Pick-Up Student*

Student&Art Photo Permission*

Enroll in Classes

Select Class

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

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I Agree to All of the Above

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