FALL 2010 ART CLASSES

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Name(s)_____________________________Age(s) _____ Grade(s) _____

Address__________________________________________________________

Phone __________________ Parent’s Names _________________________

Cell phone_______________Email address___________________________

Class Location/Time/Date________________________________

New student? _____

I give permission for my child to be treated in case of emergency at Mrs.Seitz’ discretion until I can be contacted.

Parent Signature __________________________________

Tuition:

1st Child $65 Paid Now___ Paid at 1st Class___

2nd Child $60 Paid Now___ Paid at 1st Class___

3rd Child $55 Paid Now___ Paid at 1st Class___

4th Child $45 Paid Now___ Paid at 1st Class___

Subtotal: __________

If paid one week early, Subtract $5 from subtotal.

Total Cost: _________

Check No.:_________

Please send enrollment forms to: 18285 Amberly Ln.; South Bend, IN 46637

Make checks out to Gloria Seitz.

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