Class Registration Form

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 Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Relationship

How did you learn about this class?

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

YesNo

Additional students

Date Signed

Date

Parent/guardian Name

First NameLast Name

Parent/guardian Signature

(*Manditory Feild)

My Products

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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Information