Center for Arts and Wellness CLASS REGISTRATION: 2017 -2018

Thank you for choosing the Center for Arts and Wellness for your Creative, Artistic and Wellness needs. We offer a multitude of classes and services in Music, Dance, Fine Arts, Fitness, Wellness, and Creative Education for both adults and children.

To register for any of our classes please fill out the following Registration Form. This will confirm your spot in the class.

For ALL classes, you must make a payment BEFORE the start of the first class. Payment must be made through Credit card or Pay pal using the link on the main page of our website: centerforartsandwellness.com. Payment should include $40 registration fee plus the fees for the session or first month.

See you soon at the Center!
Vandana Rao & Hema Iyengar
Co-Founders, Center for Arts and Wellness

FIRST NAME *
Your answer
LAST NAME *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
PARENT NAME(s) if student/client is under the age of 18:
Your answer
ADDRESS *
Your answer
CONTACT NUMBER (Home) *
Your answer
CONTACT NUMBER (Cell)
Your answer
EMAIL *
Your answer
EMERGENCY CONTACT NAME *
Your answer
EMERGENCY CONTACT NUMBER *
Your answer
CLASS (choose all that apply) *
Required
ALTERNATE PREFERRED DAY/TIME FOR CLASS
Your answer
KNOWN HEALTH OR OTHER ISSUES/ALLERGIES WE NEED TO BE AWARE OF *
Your answer
PAYMENT (Class Fees + Annual Registration Fee of $40) *
WAIVER *
Required
TERMS AND CONDITIONS *
Required
GENERAL COMMENTS
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Center for Arts and Wellness. Report Abuse - Terms of Service - Additional Terms