Children's Class Registration Form

Student's Name*

First NameLast Name

Caregiver's Name*

First NameLast Name

Student's age*

Are you registering for more than one student?*

YesNo

Enter additional students name(s) and ages *

E-mail*

Is the caregiver the legal guardian?

YesNo

Legal Guardian's Name*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

Medical, Health Needs or Allergies We Should be Aware of?*

NoYes

Additional Medical Info *

How did you learn about the Whitemarsh Art Center?

Would you like to receive emails from the Whitemarsh Art Center?*

Yes, email meNo, I already get them or don't want to

Purchase Options*

Toddler Clay Creations (Ages 3-5): Wed. Afternoons$325.00

While learning basic Hand building techniques like slab work, coil work, and pinch work, participants create their own clay animals, pen stands, bowls, holders and wall hangings.

Membership StatusQuantity
Item subtotal:$0.00

Add a membership$45.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

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Billing Address

Street Address

Street Address Line 2

City

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Toddler Clay Creations (Ages 3–5)