REGISTRATION FORM:

(ONE FORM PER STUDENT/COURSE)

 

Student’s Name:            ________________________________________ 

 

Mailing Address:            ________________________________________

 

            ________________________________________

If Child,

Guardian’s Name:          ________________________ Age of Child: _____

 

Home Telephone:           _____________________ 

 

Other Telephone:           _____________________

 

Email:                          ________________________________

                                                (For use only by Suffield Arts Center and Suffield Arts Council)

 

Course # / Name:           _______________________________________

 

Date(s):                         _______________________ Time(s):  ___________

 

Tuition:                          __________________

Materials Fee:               __________________

Total:                                        __________________ 

 

Make check payable to Suffield Arts Council

 

Mail to:  Suffield Arts Council, PO Box 415, Suffield, CT  06078-0415

 

Questions, call Joan Roberts 860-658-9823.

  ---------------------------------------------------------------------

For Internal Use:                

Date Received:    _______________              Date Confirmed:  _______________