If you are human, leave this field blank.Registration FormStudent's Name *Date of Birth *Grade *Parent/Guardian Names *Email *Phone # *Ideally MobileEmergency Contact NumberPlease provide an emergency contact phone number in the case that phone numbers listed above cannot be reached. Friend or Family.AddressCountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codeWill your child be picked up from AHK or go to on-campus daycare?Picked UpDay CareSchool Child Attends *Student\'s Homeroom TeacherRequired for Cambrian School DistrictNames of other adults authorized to pick up your child from AHK.Only parents/guardians listed above and adults listed in this section will be permitted to sign out your child. To add to or make changes to this list, please email AHK directly at arthousekids1@gmail.com. Allergies/Medical Problems/Concerns?REQUIRED FOR REGISTRATIONPlease Read Below: In consideration for the acceptance of my application for participation in ArtHouse Kids classes, I hereby waive, release and discharge Julie Stover and any member of their staff or families from and against any liability for any loss, personal injury, including death and property damage that may have arisen out of or in any way connected with my (my child’s) participation in the aforementioned activity. Please Choose Which Program you are registering for *Carlton Fammatre Elementary - This class is full for the Winter Session Noddin Elementary St. Leo the Great Faria - Art Explorers 1st grade (Fridays)Willow Glen Elementary Sakamoto Schallenberger Monta Loma - The TK-1st Grade class is FULLOther ArtHouse can only hold a spot in a class with paid registration. You can deduct $15 from your tuition for signing up a sibling or referring a new student who joins this session; this discount is only applicable on classes over $100 and only one referral discount is allowed per session. In the event that we fill a class we will start a waiting list for that class and possibly add a new class. We apologize but classes with enrollment of fewer than eight children may be subject to cancellation. Please drop off and pick up your child on time – $1/minute charges will be incurred after 10 min of end of class time. ArtHouse provides scholarships students in need of financial assistance. Questions? Please email ArtHouse Kids at arthousekids1@gmail.com or call 408-831-0993. Register and Pay *Course costs are: $135 $155 $185 (Please refer to the flier you received from your school)NOTE:Please type in the dollar amount for the school (numbers only) When you submit you will be transferred to paypal to pay for your class and finalize your submission. You MUST finish your payment through paypal for your registration to be complete. When you are taken to paypal you need to login to your paypal account and submit payment. If you do not have a paypal account you will be given an option to create one and then submit payment. SubmitCaptcha *reCAPTCHA is required. If you run into any problems in check out you may still pay by credit card by calling: (408) 831-0993