Document 6576595

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Register today!!!
&
Complete registration form
below and mail in or stop by
Artsplace to register.
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Finally at Artsplace...Pottery Class!
Pottery (Teens & Adults)
Wednesdays, Nov. 5, 12, 19, Dec. 3, 10, 17
6:30–8:30 pm
Working with Jan Lesnikoski of Moss Farm Studio, learn
techniques of coil, pinch pot and slab. Using rolling pins
(please bring if you have a wooden one) and special
celadon glazes, you will craft wonderful pieces of art in
this 6-week class! Choose from butter, cheese, or soap
dishes; coasters; wine caddies; and more.
$150* (includes materials, firing, and glazing fees)
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PAYMENT MUST ACCOMPANY REGISTRATION FORM; YOU ARE NOT REGISTERED UNTIL PAYMENT IS RECEIVED
Non-refundable checks payable to “CPFA” (Cheshire Performing & Fine Arts Committee)
Please mail or bring registration form and payment to: Artsplace, 1220 Waterbury Road, Cheshire, CT 06410, or call to pay with credit card.
Student’s Name:
Next line for children only:
Current Grade:
Age:
Date of Birth:
Parent’s/Guardian’s Name:
Street:
City:
Home Phone:
State:
(If other than Cheshire)*
Work Phone:
Zip:
Cell Phone:
E-Mail (PLEASE PRINT LEGIBLY):
Allergies (specify):
Alternate person to contact during class time (name/phone):
Indicate 1st choice/ 2nd choice of classes where applicable.
Class #
Class Name
Day
Time
Cost
2nd Choice
If a new student, where did you hear about Artsplace?
__ Print ad
__ Drove by and saw signs
__ Internet
__ Word of mouth
__ Facebook
__ Other ______________________
Total Class Fees
*Required Non-Resident (NR) Fee: $10 per class title = Total NR Fees*
Total Amount Due
WAIVER: Students may be photographed by Artsplace staff or news photographers for use in Artsplace promotional literature (web & print) or
newspapers. If you do not wish to have yourself or your child photographed, please sign here:
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PAYMENT
p Mastercard
p Visa
p Discover
p Cash
p Check # ________ payable to: CPFA
Card Number
Exp. Date
Name on Card (print)
Amt. Paid
Signature
Date
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