D'Ann Moxley's Art Safari - Registration Form

Registration Form - Spring 2005

Call 214.755.8130 or email D'Ann Moxley to register. Art Safari only accepts registrations by phone or email. Once registration is confirmed by phone or email, complete this enrollment form and send payment to reserve your child's place. Classes fill quickly. Class size limit is 7 students.

Student Name:
Grade:
Class:
Parent Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Mobile Phone:
Email Address:

By pressing the Submit button, I agree to the following Waiver / Release: I hearby covenant and contract to release and indemnify, save, and hold harmless D'Ann Moxley's Art Safari, from any and all claims of whatsoever nature or type of resulting from any act of commission, omission, or negligence of D'Ann Moxley's Art Safari arising from activities under or related to the enrollment of my child for which a claim, demand, suit, or other action may be made brought by any person or other entity against D'Ann Moxley's Art Safari.

Please make checks payable to "D'Ann's Art Safari". Submit this form and then mail payment to: 5715 Ellsworth Avenue, Dallas, TX 75206.