Academy of Fine Arts Registration Date_____________________________________
Please print
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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. __________________________________________________________________________________________________________________________________
Instrument/Class Teacher Day Start & End Times
2. __________________________________________________________________________________________________________________________________
Instrument/Class Teacher Day Start & End Times
_________ I have read, understand, and agree to the Procedures and Policies of the AFA.
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.
By registering for any class at AFA you give permission for AFA to use your/your child’s picture(s) for promotional purposes unless you notify
the AFA it may not use your/your child’s picture(s).
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THANK YOU Signature
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