Key West Art & Historical Society
Hidden Amidst Stone Registration Form
Fax this form to: (305)295-6649
$75.00 per week, 10% off for KWAHS members
Student Info:
First Name: _____________________________
Last Name: ___________________________________
Age:_________ Grade: ______
School: ____________________________________________________
Address:_____________________________________
City _____________State_____ Zip__________
Parent / Guardian Info
First Name_____________________________
Last Name____________________________________
Phone/Home__________________ Work___________________ Cell___________________________
Email Address_______________________________________
Emergency Contact ____________________________________Phone_________________________
Key West Art & Historical Society will be photographing students in the classroom setting for inclusion in our website and for P.R purposes. Please indicate your preference by checking the appropriate area.
____Yes you may photograph my child. _____No you may not photograph my child.
Method of Payment _____$75 per week /or ______$66 ( I am a KWAHS member)
Check - Visa - Mastercard - Amex - Cash
Cc# __________ _____________ ___________ ____________
Expire Date:_________________________
Today’s Date:________________________________
Signature on Card:____________________________
Total Paid:___________________________