Children's Registration Form

Print and mail, fax or bring to:
Shiawassee Arts Center, 206 Curwood Castle Drive, Owosso, Michigan 48867
Fax: 989.729.9134

   CHILDREN'S ART CLASS REGISTRATION Please register early

Student name______________________

Grade___________ Age______________

Parent Name________________________

Address___________________________

City/Zip___________________________

Home Phone________________________

Work Phone_________________________
	
SAC Member______Non-Member______
	

            (List classes below)
	 
Classes                       Date	                 Cost

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________


Total Payment:_____________________ 
Payment Type:     /  / Check   
                  /  / MasterCard     
                  /  / Visa      

Credit Card#
_______/_______/_______/_______

Expiration Date____________________ 


Signature_____________________________________________________