Register for an After School Art Class
Please go to www.acworthgallery.com to view details of class dates and location at your school. *If you are registering for the Winter Session at Lewis please make sure you click the appropriate payment button below. This is a 7-week session and is a lower cost; all others are 8 weeks.
Student's Name:
*
First Name
Last Name
Grade:
*
Teacher:
*
Second Student's Name:
First Name
Last Name
Grade:
Teacher:
Parent's/Guardian's Name:
*
First Name
Last Name
Dismissal:
*
ASP
Car Pick Up
Home Phone Number:
*
-
Area Code
Phone Number
Cell Phone Number:
*
-
Area Code
Phone Number
E-mail:
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Other
Country
Select School:
*
Lewis Elementary (Monday's)
Vaughan Elementary (Tuesday's)
Pickett's Mill Elementary (Wednesday's)
Frey Elementary (Friday's)
Select Session:
*
Fall 2011
Winter 2012
Spring 2012
Method of Payment:
I will use PayPal below
I will put a check in the mail
Pay with PayPal:
My Products:
Art Class - 1st Child
$
80.00
USD
Art Class - Additional Child
$
75.00
USD
Art Class - Lewis Winter Session - 1st Child
$
70.00
USD
Art Class - Lewis Winter Session - Additional Child
$
65.00
USD
Total:
$
0.00
USD
Pay by Check:
Make check payable to Acworth Gallery ~ mail to 4531 Lemon Street, Acworth GA 30101 with a copy of this form. Registration will be complete when check is received.
To Cancel a Registration:
Call Acworth Gallery at least 24 hours prior to the first day of the session in order to get a full refund, 770-313-2917.
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