Name:_______________________________________

Address: __________________________________________________________________________________

Age: ______________________

Telephone Number: H ___________________Cell__________________

 

Fee TT$ 700.00 for two weeks

Person(s) authorized to collect child(ren)______________________________________________________________________

 

Registration Number of Vehicle(s) of person authorized to collect child(ren)

______________________________________________________________________________

 

______________________________________

Signature of Parent/Guardian

Please be advised that the Art Society of Trinidad and Tobago will not deliver children into the care of any person other than the signatory  or persons specified above who are authorized to collect the child(ren.)

Please note that the sessions end promptly at 12 noon.

____________________________________________________________________________
For official use only

Amount paid:$________________________

Mode of payment: cash                                   cheque

Received by: _______________________________________