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out and mail................................................
Please sign me up for Summer Art
Classes!
Check off dates and hours you wish to join
Week 1__ Week 2__ Week 3__ Week 4__
Mornings 9:30am to 12pm________ Ages 9 to 12 or
1:30 to 4 pm____ Teens & Adults
Name of
student.................................................................................Age..............................
*Additional
student.............................................................................Age..............................
Address:.........................................................................City...............................................Zip............
Parent’s
name.......................................................Phone
#..................................
Other parent........................................................Phone #..................................
Emergency
#(s).....................................................................
Email address_________________________ for confirmation
I’ve enclosed my check $_________made payable
to Susan Ticken
Send your full payment for one week or a deposit of $200
for multi-week registration to reserve each students place, balance to be paid
at first class. Refunds given only when cancellation is more than 72
hours prior to class date. Print and fill out form and send to address below
Send to: Susan
Ticken 1337 Fourth St. San Rafael, Ca. 94901
Register before May 1st
and take $10.00 off!
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