2020 Virtual Fall Arts Academy

Student's First Name:
Student's Last Name:
Address 1:
Address 2 (Apt #):
Home Phone:
Cell Phone:
Date of Birth:
Mother's Email:
Father's Email:
Public/Private School Attending:

Select Grade: Have you previously attended Arts High/Middle School?
If yes, please list the name of the most recent class and year you attended.

Course: Year:

Session I Selection:   

Session II Selection:   


Where did you learn of our Fall Virtual Program? 

Please select payment method:  

*Virtual Course Fees: $100 per session
Name on card:
Card number:
     Expiration date:  /