Barbara’s ceramically yours

51 South 21st Street

Kenilworth, NJ 07033

Phone (908)276-1090

ADULT AND CHILDRENS REGISTRATION

DATE _________________ PHONE ____________________________

CLASS DATE __________________ TIME _______________________

NO. OF STUDENTS ________________________________________________

TOTAL DUE _______________________ CHECK # ____________________

NAMES __________________________________________________________

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(FOR CHILDRENS CLASS ONLY: PLEASE LIST AGES)

ADDRESS __________________________________________________________

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SIGNATURE ______________________________________________________

PLEASE NOTE: DUE TO LIMITED REGISTRATION PER CLASS (25) - MISSED CLASSES ARE NON-REFUNDABLE, CERAMIC PRODUCTS ARE THE PROPERTY OF EACH STUDENT AND ARE TO BE PICKED UP WITHIN 30 DAYS FROM THE DATE OF CLASS SCHEDULED.

PLEASE CALL FOR ADDITIONAL INFORMATION- (908)276-1090