Adult Class Registration
FALL 2021
Student's Name
*
Mr.
Ms.
Prefix
First Name
Last Name
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Number
*
-
Area Code
Phone Number
Secondary Contact Number
-
Area Code
Phone Number
E-mail
*
Emergency Contact
First Name
Last Name
Emergency Contact Number
-
Area Code
Phone Number
Choose Start Date
*
/
Month
/
Day
Year
Choose Class Day/Time
*
Tuesday 4:30 - 6:30 PM
Thursdays 1:00 - 3:00 PM
Fridays 4 - 6 PM
Saturday 10AM-12PM
Saturday 1-3 PM
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Registration Fee Required Annually
$
35.00
Supply Fee Required For Each Semester
$
25.00
Adult Class Monthly Registration - Once A Week Class (4 Lessons)
$
150.00
Fall Semester (September - December) Save $60
$
540.00
Spring (January - May) Save $75
$
675.00
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Total
$
0.00
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Expiration Date
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Additional Notes
I give my permission for my photo and artwork to be used in promotional material. Only first name, last initial and age will be used for credit line.
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