The Art Room Registration Form 2015 Sign up for our Group Classes,Work Shops, Camps, and Private Lessons! Required 1st Student's Name and Age 2nd Student's Name and Age Guardian’s Name (if under 18) Main Contact Phone Number Main Contact email Main Contact Address Emergency Contact Allergies or Special Circumstances Select from these Options: $25.00 One 1 hour group art lesson $30.00 One 1.5 hour group art lesson $40.00 One 1 hour private art lesson $45.00 One 1.5 hour private art lesson %15 OFF MONTHLY COMMITMENT $43.00 Spring Break One Day Camp: Monday March 23, 2015 (10am - 2pm) $48.00/day Spring Break One Week Camp: Monday March 30 - Friday April 3,2015 (9am - 3pm) $225.00/week Spring Break One Week Camp: Monday March 30 - Friday April 3,2015 (9am - 3pm) $45.00/day SmArt Camp Session One $45.00/day SmArt Camp Session Two $45.00/day SmArt Camp Session Three $390.00/ Session One: M-F June 15-26 (9 am -3 pm) 10 Days $315.00/ Session Two: M-Th July 6-16 (9 am -3 pm) 8 Days $465.00/ Session Three: M-Th July 20 - Aug 6 (9am - 3pm) 12 days % 10 OFF MULTIPLE STUDENT ENROLLMENT Other: Payment Option Payment is due prior the commencement of our services. to reserve your spot please choose one of the following options: 1) Online: if you have a PayPal account you can send money directly to my email address: firstname.lastname@example.org. To do so login to your paypal account and choose send money options. (www.paypal.com) 2) Make a Check payable to The Art Room bring in person or email to: Stacee Kalmanovsky 19521 W. University Drive Mundelein, IL 60060 Photo Release Form Please Electronically check and sign the box below if you give us permission to photograph and record your or your child’s art work, work process, and participation in The Art Room program, for use one our business website, business facebook page, and supplementary advertising materials, solely for the purpose of sharing and promoting our creativity. I allow the Art Room to take and post images of my and my students' work and participation. I prefer not to allow The Art Room to use images of my and my students' work and participation.