REGISTRATION FORM - WINTER 2024
STUDENT NAME(s):____________________________________________ AGE(s)__________
ADDRESS:__________________________________________________________
__________________________________________________________
CELL PHONE PARENT 1: __________________________________
CELL PHONE PARENT 2:__________________________________
Other CELL CONTACT: __________________________________
EMAIL:_____________________________________________________________
ART CLASS CHOICE:
CLASSES WE BE HELD FROM JANUARY 8 - FEBRUARY 28
MONDAYS, 4:15-5:30 PM _____________ $325
TUESDAYS, 4:15-5:30 PM_____________ $325
WEDNESDAYS, 4:15-5:30 PM __________ $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
301-801-4438
CHECK OR VENMO @NANCY-ALTEMUS