Children's Registration

Student's Name *

First Name

Last Name

Additional Student's Name (if registering more than 1)

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

####

Photo Release Permission *

As a parent or guardian of this student, I hereby consent to the use of photographs/video taken during the course of Kids' Pottery classes for promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use or for damages.

Yes

No

Preferred Payment Method

Online Payment

Check by Mail

Will Bring Payment to PAA

Check or Credit Card by Phone

Other

How did you hear about this class?

PAA Website

Facebook

PAA Email

Friend

Other