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