CHICO ART CENTER
CLASS REGISTRATION FORM

450 Orange Street, Suite 6 • Chico, CA 95928
Phone 895-8726

One form per class, per student.
Please make a separate check, per class.

Name of student ______________________________________Age if under 18 ______

Name of parents, if student is a minor _______________________________________

Are you a Chico Art Center member? _____ Do you wish to become a member? _____

Are you a Chico City __________________or County resident? ___________________

Address _______________________________City _________________Zip __________

Home phone _________________________Work phone __________________________

ClassTitle________________________________________________________________

Instructor________________________________________________________________

Class Dates ___________________________________________Fee________________

Make checks payable to:
(Instructors Name)
450 Orange Street, Suite 6
Chico, CA 95928

Fee received by (please print) _______________________________________________

Chico Art Center signature line _______________________________________________

Check no ____________________________Cash ________________________________

Pre-register at the Chico Art Center or by Mail.

Supported, in part, by funding from the City of Chico.