Register for an Art Camp
Student's Name:
*
First Name
Last Name
Second Student's Name:
First Name
Last Name
Parent's/Guardian's Name:
*
First Name
Last Name
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 Session:
*
June 18-22
June 25-29
July 16-20
July 23-27
Method of Payment:
I will use PayPal below
I will put a check in the mail
Pay with PayPal:
My Products:
Art Camp
$
185.00
USD
Art Camp Additional Child
$
175.00
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.
Submit Form
Clear Form
Print Form
Should be Empty:
