Class Registration Form

Class Registration Form

Information
Phoenix Center for The Arts
1202 N 3rd st PHX, AZ 85004

3rd floor
Name

First NameLast Name
Age
Phone Number

Area CodePhone Number
Email
example@example.com
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
Miscellaneous
How did you learn about this class?

Other
Option to enroll more students here: ($5/ per additional sibling *same household).
Additional students
Date Signed

MonthDayYear
Date
Parent/guardian Name

First NameLast Name
Parent/guardian Signature
Liability Waiver

(*Manditory Feild)
Payment & Confirmation
My Products
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Private Lesson $35.00
$35 per 1 hour private lesson with Teaching Artist (TA)

Quantity

Membership (Wednesdays)$35.00
After school Students can take classes (Dance/DJ/Emcee/Graffiti/Instrumentation) offered on Wednesdays Between 5-6pm

Quantity

Anti Bully class Free
Student will learn conflict resolution, self confidence and self defense.

Add Siblings $5.00
Add $5 per sibling for 1 Household

Quantity

Total $0.00
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