Child’s name _________________________________________Age________________
Parent or guardian name ___________________________________________________
Address ________________________________________________________________
City _______________________________ State __________ Zip __________________
Home phone _____________________ Work phone _____________________________
Email __________________________________________________________________

Class title ____________________________________ Fee _______________________
Class Date ___________________________________
Class title ____________________________________ Fee________________________
Class Date____________________________________
Total enclosed ____________________
Make checks payable to Sewing Lounge
Credit Card # ___________________________________
Exp. date_________________ Three digit security code on back of card ___________
Signature _____________________________________________________

Would you like to get email updates? (the list is never shared) Yes _______ No _______
May I use class photos of your child on my website? Yes _____ No________
May I use your child’s first name on my website? Yes_____ No_______

Does your child have any physical or medical condition (asthma, allergies, diabetes etc.)
or take any medications I should be aware of? Yes ____ No ____
If yes, please describe____________________________________________
If parent or guardian cannot be reached in an emergency, contact:
Name _______________________________________ Phone ___________
Individual, other than parent or guardian, authorized to pick up child from class:
Name ______________________________________ Phone ____________
By signing this registration form, I am aware and agree that:
A) Some Sewing Lounge classes have off-site field trips. My child may ride in a vehicle
with seat belts driven by a responsible adult
B) My child will only be permitted to leave class with me or with someone I have
authorized
Signature of Parent or Guardian ____________________________________
Date _____________________

Mail to: Sewing Lounge • 835 Holly Avenue • Saint Paul, MN 55104