Hull Park & Recreation Clown Art Program

Child's Name__________________________________________

Birth Date__________Age_____________Sex_______________

Address______________________________________________

City/State/Zip_________________________________________

Phone________________________Cell_____________________

E Mail________________________________________________

Parent Name__________________________________________

Insurance Company______________________Phone_________

Emergency Contact____________________________________

Special Requirements (allergies/meds)_____________________

____________________________________________________

Hull Residents $200.00    Out of town $250.00
To reserve your child's space mail registration form and non-refundable deposit of $50.00 the balance of $200.00 for out of town or $150.00 for Hull residence will be due on the first day of the program.

I give my permission for my child's photograph to be used in promotional materials

Signature_________________________________Date________

Need more information on our program call: 781-925-9793

Please print and complete the registation and mail with your check to:
Eye Candy Productions
862B Nantasket Ave
Hull, MA 02045