New Learner Information Entry Form

We look forward to seeing you!

If you are new to the Art Verve Academy, please complete the form below. All fields are required prior to submittal. Use the arrows to expand each section and make sure to click the submit button at the very bottom of the form.

PERSONAL INFORMATION
Your Name *

First Name Last Name
Preferred Gender Pronoun *

Male Female N/A
Your Date of Birth *

Month Day Year
Date Picker
Note that adults, ages 16 & up (or accompanied by a guardian) are welcome to register or enroll.

CONTACT INFORMATION
Your E-mail Address *
Your Primary Phone Number *
Best way for the instructor to contact you during enrollment? *
Email Updates?

Yes, subscribe me to the monthly newsletter.
Your Current Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

IN CASE OF EMERGENCY
Please Contact *

First Name Last Name
At this Phone Number *
Relationship to Your Emergency Contact *
Who would we be contacting?

SPECIAL ACCOMODATIONS
I have special needs that requires accommodation. *

Yes No
If yes, please explain.
i.e. you need wheel chair access, you are brining a service dog, etc.

VISUAL ARTS
How Did You Hear About Us? *
What's Your Skill Level? (Select One of the Following) *

Absolute Beginner Beginner Intermediate Advanced
What is Your Favorite Medium? *
If you have to choose one.
What's Your Favorite Subject Matter?
Do You Like Any Other Mediums?
You may list multiple, use a comma in-between
Tell Us a Little Bit About Yourself
What would you like to learn or achieve? What are your Visual Art interests?

READY TO SUBMIT
Should be Empty: