Gurukul arts Academy

home contact e-mail

ENROLLMENT FORM

Student Last Name
Student First Name
Gender
Date of Birth
Height	Cm's
Address
City
Province
Postal Code
Telephone No.
EMERGENCY CONTACTS
1. Name / Telephone No.
2. Name / Telephone No.

Any Allergies
Any Medication
Other Medication History

STUDENT INTERESTS	Dance Singing Imitation Acting Drawing Sports TV Video Games
Other Activies Currently Participating in	Dance Type : Singing Type : Sports Type : Instrument Type :
Attach your photo