2010 Art Instruction Application, Registration and Contract Form

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2010 Art Instruction Application, Registration and Contract Form

Please note that fields in bold and marked with an asterik (*) are required.

Student Name*

Address*

City*

State*

Zip Code*

Tel. (home)*

Tel. (work)

Tel. (cell)

E-mail*

Age if 18 or under

Grade if age 18 or under

Name of minor's parent

TITLE OF CLASS, WORKSHOP, OR RETREAT*

Date of Class*

TITLE OF CLASS, WORKSHOP, OR RETREAT

Date of Class

Do you need a Gift Certificate?*

If yes, Recipient's Full Name

Recipient's Address

Recipient's City

Recipient's State

Recipient's Zip Code

Date Gift Certificate is needed

Click this link to read the Contract and Terms of Agreement of registration (link opens new window).

I have read and approve the Contract and Terms of Agreement.

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Please enter the characters.

Please fill out this Application, Registration and Contract Form noting that fields with asterisks are required. Please read and approve the Contract and Terms of Agreement, then click "Submit." You will be taken automatically to the checkout where you can pay by credit card via PayPal.

Please note that you may instead print out the form and register by mail by clicking this link.

This form is for Art Instruction including Art Classes, Workshops, and Retreats. Do not use this form for the Art Where You Are™ Distance Learning Pilot Program; instead, please contact Dr. Freyermuth using the contact form.

Information on this website is intended to be descriptive. Please refer to the Contracts and Terms of Agreement for specific details.

Virginia K. Freyermuth, Inc.

2010 Art Instruction Application, Registration and Contract Form