Student’s Name: ______________________ Age: _____________
Parents’ Name: ____________________________
Phone Number: (Home)__________________________ (Cell) _______________________
Email Address: _______________________________________________
Billing Address: _______________________________________________________________
City, State, Zip Code: ___________________________________________________________
I prefer the following payment plan (please check one):
___I agree to pay a $100 nonrefundable deposit and the remaining $100 on the 1st of the next month after the class begins.
___I would like to pay the full amount $200 (including the nonrefundable $100 deposit)
Credit Card: ___American Express ___Visa ___Mastercard ___Discover
Credit Card Number: ______________________________ Exp: _________ CVC: _______
Cardholder’s Signature: _____________________________
The deposit amount is non-refundable and required to register a student. All deposits are due on or before the first day of class. Please be prepared to pay by cash, check, or credit card on the day of class. No refunds available after the first class. Payment plans will continue to be charged as agreed upon even if you drop the class. All classes contingent upon adequate enrollment; should a class be cancelled due to insufficient enrollment refund will be issued.
If you have any questions or wish to complete registration over the phone, please contact Abby Felder, Asheville Creative Arts. 914-830-3000 or email@example.com.