REGISTRATION FORM -FALL 2021

STUDENT NAME(s):____________________________________________  AGE(s)__________

ADDRESS:__________________________________________________________

 

             __________________________________________________________

CELL PHONE PARENT 1: __________________________________

CELL PHONE PARENT 2:__________________________________

Other CELL CONTACT:  __________________________________

EMAIL:_____________________________________________________________

ART POD CHOICE:

 *NOTE: CLASS SIZE IS LIMITED TO INSURE SAFE SOCIAL DISTANCING AND FACE MASKS ARE REQUIRED. THANK YOU.

 

  MONDAYS, 4:15-5:30 PM ______________ STARTING SEPT. 20 (8 weeks)    $325

  TUESDAYS, 4:15-5:30 PM_______________STARTING SEPT. 21 (8 weeks)    $325

  WEDNESDAYS, 4:15-5:30 PM ____________STARTING SEPT. 22 (8 weeks)    $325

  THURSDAYS, 4:15-5:30 PM  _____________STARTING SEPT. 23 (8 WEEKS)   $325

 I/WE THE UNDERSIGNED, PARENTS OF, _____________________________, A MINOR, DO HEREBY RELEASE AND HOLD HARMLESS YOUNG AT ART AND NANCY AND MARK ALTEMUS (HEREINAFTER "OWNER") FROM ANY CLAIMS FOR PERSONAL INJURY OR OTHER DAMAGE ARISING FROM MY/OUR CHILD'S ATTENDANCE AND PARTICIPATION IN THE PROGRAM LOCATED AT 4112 DRESDEN STREET, KENSINGTON, MD. 20895

PARENT SIGNATURE:______________________________________________________

 

 

                                                         SEND PAYMENT TO:

                                                 NANCY ALTEMUS/YOUNG AT ART

                                          4112 DRESDEN STREET, KENSINGTON, MD 20895

                                                OR VENMO @NANCY-ALTEMUS