Please fill out ALL FIELDS, print form, and mail to the address below with payment.
Student Name:__________________________________
Date of Birth (MM/DD/YY):____________
Grade in School:_______________
Parent/GuardianName:________________________________________
Address:_______________________________________________________
City: ______________________________
State: ____________Zip:________
Email address:__________________________________________________
Phone numbers: Home: __________________
Work or Cell: _____________
Contact (in case of emergency):__________________ Phone:_______________
COURSE TITLE /DAY/TIME_______________________________________
SESSION(S) - FEE:_____________________________
Please mail registration form and payment to:
Pencilworks Studio
96 Main Street
Little Falls NJ 07424
(Make checks payable to Pencilworks Studio)
.
