Name of Student:    Age (if minor):
Person Responsible for Billing: 
Class # you would like to attend: Month: Day:
Enroll me in this class  This class is full, Please put me on the waiting list
Address: City:
State   Zip Code:
Telephone: Emergency Number:
Email Address:

Name:      Telephone:
Email address:

Please contact me with the information about the following:
Kid's Summer Classes           My Account or Bill
Prints By Harold Petersen      Please withdraw me from the class below

Additional information:

email us at info@petersenartcenter.com