After School & Art Club Registration Form

* Required fields
Name *
E-mail Address *
Childs Name
Age / DOB
School & Grade
Address / City / Zip
Phone Number Cell & Home
Emergency Contact / Name & #
Allergies / Special Concerns


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Click here to REGISTER!

The Little Paintbrush --- 104 Rena Dr, Lafayette, LA 70503 --- 337-288-7266

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