Heart & Hands Art Center Registration

Registration Form for Heart & Hands Art Center
phone: 845-313-2915

Please print this form, complete all fields and send to the address above for registration.
Class information is available on the internet at: http://www.heartandhandsartcenter.com

Name:

Address:

City:

State:

Zip:

Phone:

Emergency Contact:

Emergency Telephone:

For children: Are there any physical or medical problems instructor should be aware of?
Yes / No Please Explain:

Day:

Time:

Tuition per month due at the first lesson of every month.

Please make checks payable to: Heart & Hands Art Center.
Family discount available for siblings ($5.00 each child per month).

Tuition for adult workshops will be paid to guest instructors directly.

Name:
Address:
City:
State:
Zip:
Phone:
Emergency Contact:
Emergency Telephone:
For children: Are there any physical or medical problems instructor should be aware of? Yes / No Please Explain:
Day:
Time:
Tuition per month due at the first lesson of every month.
Please make checks payable to: Heart & Hands Art Center. Family discount available for siblings ($5.00 each child per month). Tuition for adult workshops will be paid to guest instructors directly.