REGISTRATION FORM FOR CHILDREN’S CLAY CLASSES @ TPG
(Print and mail or deliver with payment)
CHILD’S NAME: ___________________________________________________
PARENT/GUARDIAN’S NAME: ________________________________________
ADDRESS: ___________________________________________________ Mail to:
CHILDREN’S CLASSES
CITY: ___________________________________________________ TOLEDO POTTERS’ GUILD
STATE: __________________ ZIP: ___________________________ 5403 ELMER DRIVE
DAYTIME PHONE: ____________________________________________ TOLEDO, OHIO 43615
EVE./OTHER PHONE: ____________________________________________
E-MAIL ADDRESS: ____________________________________________
SESSION: (circle) Winter (Begins Jan. 4, 2012 )
Class will meet on Wednesdays from 4:00-6:00, for 10 weeks beginning January 3rd.
You will only be notified if we are unable to place your child in the class.
Instructor: Deb Simoff, 419-203-3977
FEES: TUITION (10 CLASSES) SUPPLY FEE CLAY FEE TOTAL PAYMENT DUE
$135.00 $17.00 $10.00 $162.00
METHOD OF PAYMENT: (circle) CHECK (MADE PAYABLE TO TPG) MASTERCARD VISA DISCOVER
Due to bank requirements, please bring credit card to the first class for payment processing.
BY SIGNING THE BOTTOM OF THIS FORM, I AFFIRM THAT I HAVE READ THE TPG CHILDREN’S CLAY CLASS INFORMATION PUBLISHED
WITH THIS REGISTRATION FORM. FURTHERMORE, I AGREE TO ACCEPT THE STATED TERMS AND CONDITIONS FOR PARTICIPATION
IN THE CLASS, INCLUDING INSTRUCTIONAL OFFERINGS AND CLASS PAYMENTS. CLASS FEES WILL BE REFUNDED TO ONLY THOSE
INDIVIDUALS WHO WITHDRAW PRIOR TO THE FIRST CLASS SESSION, OR IF A CLASS SECTION IS CANCELLED DUE TO INSUFFICIENT
ENROLLMENT.
SIGNATURE: (indicating acceptance of terms) ______________________________ DATE: _____________________________
Mail or hand deliver this completed registration form along with your payment.
If mailing, please send to the address noted above; envelope must be postmarked no later than 6 days before the first week of class.