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Registration Form


Name:____________________________________________________

If youth, age and grade:_________________________________

Name of guardian(s):_____________________________________

Address:_________________________________________________

_________________________________________________________

City: ______________________ State:______________________

Zip: Home phone:_________________________________________

Cell: Work:______________________________________________

Email (please print clearly):____________________________

Class #/Title/Day of week__________________________

_________________________________________________________

_________________________________________________________

Class #/Title/Day of Week__________________________

_________________________________________________________

_________________________________________________________

 

For more info call 423-320-6738

Classes will be at James A Henry Bldg. SPLASH Art Studio located at: 1200 Grove Street, Chattanooga, TN 37402