2015 Summer Class Registration Form

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Jack Zheng Art Studio

2015 Art Class
Registration Form
Address: 3869 Cheryl Ct, Aurora, IL 60504
Phone: (630) 618 - 8715 Email : jackzhengart@gmail.com

Student Information

* Indicates required field

Todate's Date *

Student Name *

First

Last

School *

Grade *

Age *

Years of Studying Art *

Never < 1 year 1 year 2 years 3 years >3 years

Address *

Line 1

Line 2

City

State

Zip Code

Country

Gender *

Male Female

How do you hear about us? *

Internet Friend School Other

Parent/Adult Contact

Primary Name *

First

Last

Primary Phone Number *

Name *

First

Last

Phone Number *

Primary Email *

Email *

Primary contact *

Mother Father Other Adult

Optional Contact *

Mother Father Other Adult

Select Class

Class Type *

1 1/2 hour class - $25/class 1 - hour class-$20/class

Comment *

Submit

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