Registration Form

Name____________________________________________________________________________

 

Address________________________________________________________Aptno.__________

 

City___________________________________________State_________Zip_____________

 

Home Phone_______________________________Work_______________________________  

 

Cell___________________________Email______________________________________________

                                                                  (please print legibly)

1st choice

Course Title: __________________________________________________  

 

Day & Time:____________________________________

 

Tuition $ ______________ 

 

Materials & Firing Deposit: $50

 

Total: $______________

 

2nd choice (back-up class in case 1st choice is full or cancelled)

Course Title: _________________________________________________

 

Tuition $ ______________    

 

Day & Time:___________________________________

 

Materials & Firing Deposit: $50

                         

Total: $______________

 

It is assumed that all students have read, understand and agree to: Studio Policies; Prices; documents located on the Academy website: nynjceramics.com

Refunds will be issued only if a class is cancelled, in which case you will be notified within 48 hours of the first session. Also note that your tuition covers the ten-week session, not broken down into individual classes. Your tuition cannot be prorated for individual classes.

NY/NJ ACA is not responsible for providing makeup classes or issuing refunds for classes missed as a result of illness, emergencies, weather conditions, absenteeism, or any situation beyond our control.

I understand fully, and agree to the above stated refund policy.

 

Signature_____________________________________________

 

______Please charge my credit card.   MC / Visa / AmEx/ Discover

 

#_____________________________Expires_________*Security Code: __________

* This three or four digit number can be found either on the front (Amex) or on the back of the card (Visa/MC) on or near the signature strip. Submitted registration forms without this number are not valid.

 

Name as it appears on the card

:___________________________________________________

 

Billing address for the card, if different from the address above:

__________________________________________________________________________