Savannah's Clay Spot Registration Form

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Name of class you are registering for

Day class is held on

Class Time

AM Class 9:30am-12:30pm

PM Class 6pm-9pm

PM Class 5:30pm-6;00pm

Other:

Session Name

Name *

Address *

City *

State *

zip *

Cell phone # *

Evening Phone #

Email Adress *

Please complete the following for students under 18

Age of child student only

Date of Birth

Parent or Guardian Signature

Emergency Contact Phone #

Total amount Due *

Method of Payment *

Pay by check

pay by credit card

type of credit card

Amex

Mastercard

Visa

Clear selection

Card number

Expiration Date

Name as it appears on the card

CV number

the three digit number on the back of your card, american express is on front of card

Submit

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