PLEASE PRINT REGISTRATION AND MAIL TO: Essex Art Center - Att. REGISTRAR, 56 Island St. Lawrence, MA 01840

Payments - We accept checks* or cash. Payment must be made at the time of registration. To register please send in the complete form with payment or come visit us at the Essex Art Center. No Phone Registrations Accepted. *RETURNED CHECK FEE is $30 payable in cash or by money order Cancellation & Refund Policy - We reserve the right to cancel classes if the minimum enrollment is not reached. Full cost will be returned if the class is canceled due to low enrollment. NO OTHER REFUNDS will be given. Weather Cancellations - If Lawrence Public Schools are cancelled due to bad weather, all EAC classes are cancelled for children and adults. EAC does not make up these canceled classes. Class fees - Class fee includes a limited amount of supplies and we do have limits on materials in certain classes. Please ask when you register. NO CONFIRMATION OF REGISTRATION GIVEN - ONLY NOTIFIED IF CANCELLED.

HOUSEHOLD CONTACT

First Name: Last Name:

Address:

City: State: Zip:

Home Tel: Other Tel:

E-mail:

Emergency Contact Name: Emergency Tel:

STUDENT INFORMATION (you can register up to 5 family members on one form)

1) First Name: Last Name: Age (if child):

New or Returning Student Course Title Day/Time Cost

2) First Name: Last Name: Age (if child):

New or Returning Student Course Title Day/Time Cost

3) First Name: Last Name: Age (if child):

New or Returning Student Course Title Day/Time Cost

4) First Name: Last Name: Age (if child):

New or Returning Student Course Title Day/Time Cost

5) First Name: Last Name: Age (if child):

New or Returning Student Course Title Day/Time Cost

Additional Donation

TOTAL Paid by Cash or Check