Participant Registration Form

Participant Registration Form

Register now to participate in our next "Let’s Play to Beat Breast Cancer” class, Sunday May 3rd at 2:30pm. Maximum of 10 participants.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
A $5 donation (collected at the door) is kindly requested to help cover art supplies.
Liability Disclaimer: By registering for this class, I release Monique Carr and any assistants or venues from any liability for injuries, accidents, or damages that may occur during or as a result of my participation. I agree to take full responsibility for my own safety and well-being during the class.
Should be Empty: