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**

THE PICK & PAINT POTTERY SHOP ART CAMP- Total Cost is $150 plus tax per session. A non-refundable deposit of $25 per session is required to secure this registration.
Session 1
(5 days)
Garden Fun		 July 19 - July 23
 

$25 NON-REFUNDABLE DEPOSIT
Session 2
(5 days)
Around  the World		 August 2 -  August 6

$25 NON-REFUNDABLE DEPOSIT
 
Session 3
(5 days)
Mirror Party		 August 9 - August 13

$25 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:______________________
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