egistration Registration Form Form
ater Street Water Studios, Street School Studios, of ArtSchool of Art
S. Water Street,160 Batavia, S. Water IL 60510 Street,Batavia, 630.761.9977 IL 60510 waterstreetstudios.com 630.761.9977 waterstreetstudios.com stions contact: Kari Questions Kraus,contact: DirectorKari of Education Kraus, Director kari_l_kraus@sbcglobal.net of Education kari_l_kraus@sbcglobal.net info@waterstreetstudios.com info@waterstreetstudios.com
me:__________________________________________________ Name:__________________________________________________ Contact # (_______) Contact _______-__________ # (_______) _______-__________
ress ________________________________________________ Address ________________________________________________ City_______________________________ City_______________________________
e________ ZipState________ _____________ Zip _____________ Email _______________________________________________________ Email _______________________________________________________ Student’s Name
Student’s Name Class Title
ease check if f allergies Please* check if f allergies*
Class Title Class Date(s) ClassCost Date(s) Student and session # if applicable and session # if applicable age (if
Cost
under 18)
Total:
Student age (if under 18)
Total:
hod of Payment: Method Check of Payment: # _______ Check Cash # _______ Gift Certificate Cash _______ Gift Certificate Other _______ _______ Other _______ Credit (if mailingregistration, Credit (if mailing pleaseregistration, see below) please see below)
Children’s Classes For Children’s Only: Parent Classes Contact Only: # (_______) Parent Contact _______-__________ # (_______) _______-__________
cial needs/concerns/requirements Special needs/concerns/requirements that we need to bethat aware weof: need ______________________________________ to be aware of: ______________________________________
_______________________________________________________________________________________ __________________________________________________________________________________________
_______________________________________________________________________________________ __________________________________________________________________________________________
Allergy information:________________________________________________________________________ *Allergy information:________________________________________________________________________
_______________________________________________________________________________________ __________________________________________________________________________________________
ve read, understand I haveand read, willunderstand abide by the andpolicies, will abide rules, by the andpolicies, regulations rules, of Water and regulations Street Studios of Water (on back) Street_____. Studios (on back) _____. initial here
initial here
es! I would liketoYes! volunteer, I wouldplease like tocontact volunteer, me please about volunteer contact me opportunities: about volunteer __________________________ opportunities: __________________________
For office use only:For Date office Received use only: ____/____/____ Date Received ____/____/____ Date Processed ____/____/____ Date Processed ____/____/____ Initials________ Initials________ _ _ _ _ _ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ _ _ _ _ _ _
ase note: CreditPlease Card information note: CreditisCard removed information from this is removed form and from shredded this form afterand processing shreddedforafter security. processing for security.
isa
MasterCard Visa
MasterCard
Expiration Date________________ Expiration Date________________
dit Card # _____________________________________________________________ Credit Card # _____________________________________________________________ CVV # _____________ CVV # _____________
me as it appearsName on card as it(please appears print)__________________________________________________________ on card (please print)__________________________________________________________
dholder’s Signature Cardholder’s ________________________________________________________________________ Signature ________________________________________________________________________ rev08_10