Berke Art Registration Form

Berke Art Registration Form

Berke Art studio
Student Information
Name*

First NameLast Name
Age*
Gender*

MaleFemaleN/A
Disability*

NoYesN/A
Mobility Level

Level A (Walking Stick)Level B (Walking Frame)Level C (Wheelchair-Stand in one leg)Level D (Wheelchair)Level E (bedridden)
Allergies:
e.g. Nut allergies
Art level

beginnerIntermediateAdvanced
Workshops & Courses

WorkshopCourseIntroduction (Trial)
Kids Classes

Ceramic/Clay Hand-BuildingPaintingWheel Throwing
Adult Classes

Ceramic/Clay Hand-BuildingPainting (Modern with Texture)Painting on CeramicResinWheel ThrowingPainting (on Fabric)Stained Glass (Vitray)Wheel Throwing for Kids and Parent
Select a date for an appointment or free introduction
Please note that the maximum capacity for each class is 5 people. Classes will not run with less than 4 people in it. If the minutemen requirement is not met, the class may be rescheduled or canceled.
Phone Number*
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Write something about yourself
Parent/Guardian Information

For below 18 years of age
Parent/Guardian Name

First NameLast Name
Phone Number
Email
example@example.com
Relationship
Other
How do you learn about this online art class?*

FacebookInstagramYouTubeSearch EngineOnline AdsReferralPosterOther
Payment & Confirmation
Payment Method

CashPayPalOther
Registration Fee
prevnext( X )
Art Workshop1 Hours
$35.00AUD Quantity



Art workshop Kid with Parent1 Hours
$60.00AUD Quantity



Art Course 4 session 1 hours
$130.00AUD Quantity



Family workshop 1 Hours (Maximum 5 person)
$140.00AUD Quantity



Total

$0.00AUD
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
If you have any questions, please email or call us using the details below:

Berke Art Academy
n.msvnd@gmail.com
Instagram: @berke_gallery

0451614413 & 0414361741
Should be Empty:

Berke Art Registration Form

Student Information

Parent/Guardian Information

Other

Payment & Confirmation