Benida's
Registration
Name of child_________________________Age______M / F
..............................................please print
Parent or Legal Guardian______________________________
Address__________________________________________
Phone___________________cell_______________________
Email_____________________________________________
Emergency ______________________phone______________
Amount enclosed $____________
Release:
Benida's Clay • Art Workshop, Benida Solow and Ron Grant are not responsible for any damages to or loss of personal possessions or any bodily injuries that may incurred during the workshop. There are no make ups for missed classes
Signed____________________________Date____________