Registration Form - Fall 2008 - Spring 2009

Please print this page and fill out the form to register. Mail the registration form and registration fee to the address below.

Student's Name__________________________________________ Phone_______________________________

Street__________________________________________________ City_________________________________

State_______________________________________ Zip__________________________________

Grade______________________ Age____________ Adult______

Email__________________________________________________

1st choice (day & time )___________________________________

2nd choice (day & time )___________________________________

In case of emergency contact: Name___________________________________ Phone______________________

Please enroll the student named above in Art & Design Studio of Rockland, Inc. I have read this form and the studio brochure, and I understand and accept all Art & Design Studio of Rockland, Inc. rules and enrollment conditions.

Signature _____________________________________________________ Date__________________________

Please enclose the registration fee (1 month of tuition) to assure your place in the class. If you attend classes in June, this non-refundable fee will be credited as your June payment (not applied to any other month). Tuition will be due by the first class of each month.

Make checks payable to: Art & Design Studio of Rockland - Sign, date and mail this form with the registration fee to:

Art & Design Studio of Rockland
149 S. Middletown Road, Suite 3
Nanuet, NY 10954

If you have any questions you can e-mail us or call 845-624-2426.

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