Me and Clay ™ Registration Form

Please, use this form if you want to pay by Check. Fill this form and mail the payment to: Me and Clay ™, 10805 Hess Drive, La Mesa, CA 91941. No payments accepted in the school’s front office. Checks payable to Me and Clay ™. (You can upload Registration form and do all registration Off line, if you wish.)

Your School Name

Please, write your school name

Child's name

First Name

Last Name

Child's grade

Teacher's name + Classroom number

Please, write your child teacher's name and the classroom number so we know where to find your child if needed. TK and K are automaticly picked up from their classrooms, older kids walk to Me and Clay class by themselves.

Second Child/if applicable

Child's name

First Name

Last Name

Child's grade

Teacher's name + Classroom number

Third Child/if applicable

Child's name

First Name

Last Name

Child's grade

Teacher's name + Classroom number

Parent's info

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Phone

(###)

###

####

Email Address

Authorised Pick up Person

First Name

Last Name

Authorised Pick up Person Number

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Number

(###)

###

####

Please list any special needs or health concerns:

I give permission for my child’s artwork to be used by Me and Clay on its website and for any related publicity, including print and broadcast media.

Yes

I give permission for my child's photograph to be used by Me and Clay on its website and any other related publicity, including print and/or broadcast media.

Yes

Release of Liability: We at Me and Clay do our very best to provide a safe art making environment. In consideration for the privilege of participating in this program, I hereby release and hold harmless Me and Clay for any injuries during class time. Me and Clay is not responsible for children after or before the stated class times. We pick up the TK and K grades children from their classroom. *

Please, type your signature.

Me and Clay Refund Policy: I understand and agree to the following: No refund after the second class is held. Student will get a full refund if the class is canceled by Me and Clay. No refund for missed classes No make-up classes possible.

Please, check

Please, bring the payment - check order to Me And Clay to the first class. Please, DO NOT leave any checks in the school office. Thanks. Today's date

YYYY

Signature (type your name)

Jana Kenney Ceramic Art Classes for Kids-21.jpg

Me and Clay

10805 Hess Drive

La Mesa, California 91941

(619) 681 4493

MeAndClay2018@gmail.com

Jana School Ceramics December 2016-80.jpg