Registration form for classes, workshop and special events


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543 Newfield Avenue, Stamford, CT 06905

* required information

2012 REGISTRATION FORM

TO ENROLL: Email or call to confirm availability, fill in this form, print & mail with a check made to Lakeside Pottery

_{Press "Tab" to go to the next field}

* Program Name:

8 wk adult, 8 wk children, camp or workshop - Classes Info

* Start Date /Time:

Example: Sat 9/8/12 / 10:00AM -- To Calendar

Program Fee:

Adults or Children 8 wk program = $365; 6 wk program = $275; 1 wk camp = $275

Tool-set:

Please pay $20 now if don't have a tool-set

T-shirt (optional):

$20 - Lakeside Pottery T-shirt w/ print in front & back. (call or e-mail for color)

Enclosed check #

Paid with charge card

* TOTAL:

Student's Information

_{Second Student}

* _{Student Name:}

Name 2:

* Street:

_{How did you hear about us?}

Street:

* City/State/Zip:

Children's Programs Info:

* Phone - Day:

* Kid's Age:

Allergies:

* Phone - Eve:

* Parent name:

* E-mail:

Comments:

Cancellation and Rescheduling: Lakeside Pottery LLC reserves the right to cancel, combine, or reschedule classes in order to adjust for enrollment. The minimum number of participants needed to establish a class is six. If Lakeside Pottery cancels a class due to insufficient enrollment, registered participants will be informed and given the opportunity to register for another class. If participants do not want to transfer, a full refund will be given. Tuition is refundable only with at least two weeks notice before the start of class. $25 cancellation fees. Private lesson $50 deposit is refundable only with at least three days notice. Missing Class Policy

SIGNATURE:

DATE:

I read the above

Pay with PayPal or Charge Cards (3% Fee)

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