By completing this form, I agree to comply with The Pick & Paint Pottery Shop policies and procedures. 
Artist's First Name Last Name
Parent's Name
Street CityState Zip
Day Phone   Evening Phone   
Cell  
e-mail  DOB:   DAY: YR:Boy Girl
Emergency Phone #s (friend and/or relative if parent cannot be reached)
Name Phone #  
Name Phone #   Age during camp session  

**Please let our staff know of any pertinent information about your child, such as, allergies, medication, or special needs**

***Children are required to bring their own lunch. A snack will be provided to all.***

THE PICK & PAINT POTTERY SHOP ART CAMP- Total Cost is $170 plus tax per session. A non-refundable deposit of $50 per session is required to secure this registration.
Session 1
Mad Hatter Tea Party		 July 27- July 1
 

$50 NON-REFUNDABLE DEPOSIT
Session 2
Around  the World		 July 11- July 15

$50 NON-REFUNDABLE DEPOSIT
 
Session 3
Peace, Love and Paint Pottery		 July 25- July 29
 

$50 NON-REFUNDABLE DEPOSIT
Session 4                                    Sweet Treats August 1- August 5
 

$50 NON-REFUNDABLE DEPOSIT
Session 5                                  Mirror, Mirror on the Wall                               August 8- August 12

$50 NON-REFUNDABLE DEPOSIT
 

Method of Payment

*DISCOUNTS:
Check #                         

Cash: $25 NON-REFUNDABLE DEPOSIT

Credit Card

Card Number  ---

Expiration Date  -

Signature ____________________________________________
Print this form, sign, then mail or fax. You can also just come to our shop and drop it off
(Ph)854-3616  (Fax)878-4135

The Pick & Paint Pottery Shop
14 Cumberland St
Westbrook, Maine 04092                             

 

*Receive $10 off the camp fee for each additional sibling.

*Receive a $20 discount if you sign up for 2 sessions.

*Receive a $60 discount if you sign up for all 3 sessions.

 ____________________________________________
FOR OFFICE USE ONLY

Amount Paid:________________________

Amount Due:_________________________

 Staff:______________________
1