REGISTRATION FORM send to: 2227 Cole St, Birmingham, 48009 (248) 258-2900

Last Name_____________________________________ First Name_____________________________

Street Address_____________________________________ City/State/Zip

Home Phone ________________________________Work Phone___________________________ Cell Phone________________________________

E-mail Address

Parent’s Name if Student is Under Age 18 Birth date of student

CLASS ____________________________________________DATE ________________FEE_____________

CLASS____________________________________________ DATE________________ FEE_____________

CLASS____________________________________________ DATE________________ FEE______________

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Optional Optional

Snack credit $10 per week_________ Lunch Hour $20 per week_____________ ************************************************************************************************************

Total Due___________________________ $50 per camp Deposit _____________________

Balance Due ________________________________ MC/Visa # _______________________________________Exp.Date_______________

Account Name ________________________________Billing Zip Code____________

Check # ___________________________ (preferred form of payment)

• A $50 deposit per camp with a check will hold your spot. Make checks out to Wonderworks Art Studio. The
remainder balance will be due one month prior to camp start date. This can be paid by check, MC or Visa.
• All other classes should be paid in full at time of registration.
• Cancellations will be accepted up to five days before class/camp starts. Refunds will be issued minus a $5 processing fee.
No refunds will be issued after a class starts. If Wonderworks Art Studio cancels a class due to low enrollment, a full refund will be issued.

Final

Emergency Contact Info

Parent/Guardian_____________________________Phone______________________________

Parent/Guardian_____________________________Phone______________________________

Health or Food Concerns_________________________________________________________

Insurance Carrier______________________________#_______________________