CHALKlets Application

CHALK of Hermosa

Child's Information

Child's NameDate of Birth

MaleFemale

Parent/Guardian Information

Name Relationship to the Child Email Address Phone Number Address Address Line 2(Optional) City State Zip Code

Emergency Contact Information

Name Email Address Phone Number Relationship to the Child Address Address Line 2(Optional) City State Zip Code

Name of the Adult Attending Class with the ChildSession

By submitting this enrollment application, the Parent/Guardian above understands and accepts the following policies: The $500 class fee is non-refundable and non-transferable if the child is accepted into the program. We do not offer makeups or price adjustments for missed classes.

I Understand and accept the policies.