Katonah Art Center

Page 1

Registration Form Student Name

D.O.B. (under 18)

Parent/Guardian Address Email Address

Phone#

Cell Phone#

• Class Name

Day

Time

Fee

Semester

• Class Name

Day

Time

Fee

Semester

• Class Name

Day

Time

Fee

Semester

Additional Student

D.O.B. (if under 18)

• Class Name

Day

Time

Fee

Semester

• Class Name

Day

Time

Fee

Semester

Fee

Semester

Total Fees

• Class Name

Day

Time

Please make checks payable to: Katonah Art Center MAIL: 131 Bedford Road, Katonah, NY 10536 PH# (914) 232-4843, FAX (914) 232-3322 www.katonahartcenter.com Please take note of all policies, holidays and descriptions Credit Card Type Expires

/

Total Fees

Credit Card # Sec. Code

Check #

Date


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