Art Class Registration Form

Art & Mindfulness Class

Registration Form

Circle Class

Prek-2nd Grade

Tuesdays

10 am - 10:50 am

Start - March 7th, 2023

Age group: PreK - 2nd grade

Topic: Mindfulness and Art

Star Class

3rd through 6th Grade

Tuesdays

11 am - 11:50 am

Start - March 7th, 2023

Age group: 3rd - 7th grade

Topic: Mindfulness and Art

Teen Class

7th grade +

Tuesdays

12 pm - 12:50 pm

Start - March 7th, 2023

Age group: 7th grade and up

Topic: Mindfulness and Art for Teens

Student Information
Name

First NameLast Name
Age
Gender

MaleFemale
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Name
School Level
Write something about yourself
Parent/Guardian Information

For minors (below 18 years of age)
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship
Other
How do you learn about this online art class?

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Do you want to add enroll more students?

YesNo
Additional students
Payment & Confirmation
Registration Fee
prevnext( X )
Circle Class Prek-2nd Grade$25.00

Quantity

Star Class 3rd through 6th Grade$25.00

Quantity

Teen Art Class 3$25.00

Quantity

Total $0.00
Payment Method (payment received at beginning of first class)

CashCredit CardCheckPayPalOther
Please only sign if you're 18 years old and above otherwise, leave it blank and have your parent/guardian signed the next signature field.
Signature of Student

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Date Signed

MonthDayYear
Date
Parent/guardian Signature

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Date Signed

MonthDayYear
Date
The relevant links will be provided in the autoresponder email after you successfully registered.

If you have any questions, please email, text, or call us using the details below:

The Family Center of Tallassee
www.familycentertallassee.com
hello@familycentertallassee.com
334-384-4504
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Art & Mindfulness Class

Student Information

Parent/Guardian Information

Other

Payment & Confirmation