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out and mail................................................
Please sign me up for Summer Art
Classes! July 6 to July 31st, 2015
Check off dates and hours you wish to join
Week 1__ Week 2__ Week 3__ Week 4__
Mornings 10am to 12:30pm________ Ages 9 to 13
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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