Bring the bottom half of this form into the Mott Public Library with payment attached to secure your spot. Keep the top portion for your information. Class size is limited. Register Early.
Theo Art School
Mott Gallery of History and Art
And Mott Public Library Bring you
ACRYLIC AND CANVAS
Fine art entertainment and instruction for the entire family.
June 20, 2015
All Supplies and Materials are included. 25 dollars per person per session Payment is due at Registration
Checks/Money Orders made out to City of Mott. Class Size is Limited
Adults, Families and Children 21 and over
9:30-11:30 1: 30-3:30 5:30-7:30
Student One: First________________ Last______________________________
Student Two: First________________Last______________________________
Student Three: First_______________ Last______________________________
Student Four: First________________Last______________________________
Student Five: First_________________Last______________________________
Student Six: First_________________Last______________________________
Contact/Parent/Guardian: First_________________ Last____________________
Address: _____________City______________State____________Zip_________
Home Phone:_____________________ Cell Phone:___________________
Emergency Contact Info: Name __________________Number______________
Session: 9:30 1:30 5:30 (21 and over only)
- Yes, I give permission to the Mott Public Library, Mott Gallery of History and Art and Theo Art School to use my photos, my children’s photos and photos of my/our artwork in publications and on websites of the above listed entities.
Amount attached:_________ Number of Students: _________
Contact Signature and Date:____________________________
