We have been experiencing technical difficulties with our registration form.  For those of you that completed a registration form between 12/1/12 through 1/18/12. Please either complete another registration form or contact us at 856-379-6987.  We apologize for the inconvenience. 

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REGISTRATION FORM

Student Name*


Address


Gender

Age


Parent/Guardian’s Name*

Phone (number’s only, including area code)


Emergency Phone* (number’s only, including area code)


Number Of Classes


Name of Class*
Morning
Dance
Drama/Theatre
Visual Arts/Painting/Drawing

Afternoon Classes
Graphic Design
Digital Photography
Music Production
Sound Engineering
Video Production/Sound/Editing

Number Of Weeks


Parent Signature*


Name of CardHolder*


Card Type*
MasterCard Visa American Express Discover Bank
Total Amount Due


Please Indicate Any Special Needs
(300 character max)

E-Mail*


Picture
Click Image for PDF version
DISCLAIMER: 
I will hold harmless the IDEA Saturday Arts Creation Station and any of its agents, directors, employees and supervisors for any responsibility or liability for any injuries or property damage which may arise from my or my child’s participation in this program. I understand that in  the event of an injury, my own personal medical insurance will be used. 
 CANCELLATION: 
Cancellation refunds are available under the following circumstances: one month prior to class start 10%, two week before classes start 25% fee. No refunds after classes have started. If you have questions or would like more detailed information, please call IDEA at (856) 379-6987