Student's Name:________________________________    Age:______

Parent's Name:______________________________________________

Home Phone:________ Work Phone:_________Cell or Pager#:_______

Address:___________________________________________________

City/State/Zip:______________________________________________

Sun Gallery requires that all children be signed in and out by an authorized adult. Please, list the adults authorized to sign your child in and out.

1.________________________________________________________

2.________________________________________________________

3.________________________________________________________

Emergency Contact:

1.________________________________________________________

2.________________________________________________________

Please Indicate which session(s) you would like your child to attend:

Session#:_________________    Session #:_____________________

Session#:_________________    Session #:_____________________


Amount Paid:______________________________________________

To Pay Tuition: We accept cash, checks (payable to Sun Gallery) or credit cards. You may mail, telephone, fax or deliver your payment. Tuition is $200.00 a child per week-long session.

Enclosed is my check

Please charge tuition to

VISA

Mastercard

AMEX