Student Registration

Student Name(s): *

Age(s): *

Parents Names: *

Home Phone #: *

Mobile Phone #:

Work Phone #:

Contact person: *

Email address: *

Mailing Address: *

Postal Code: *

Health/Allergies/Special Needs/Behavioral issues: *

It is important to give us as much details as possible about your child/ren so we can make sure we have the right support systems in place so everyone has sucessful camp experience. If you do not inform us in detail about your child special needs or behavioural issues then we have the right to send your child home without refund. By submitting this registration form you agree to these terms.

What Pottery Class/Camp/Workshop/Lesson have you taken?: *

Can we use images of you or your children for promotional or media use? : *

Yes

Would you like to be on Majestic Mud Pottery mailing list?: *

Would you like to be on Muddy Music Centre mailing list?: *

How did you hear about The Muddy Music Centre?: *

Which Camp are you registered in?: *

To register for multiple workshops, hold the Ctrl key on your keyboard while you click different entries.

Do you need extended child care: *

This will be add manually to your total balance

How are you submitting payment?: *

If mailing in cheque make the cheque out to Muddy Music Centre, 141 Whitney Place #25B, Kitchener, On, N2G 2X8. Also please write on cheque the week, the camp, the students name

Refund and Cancellation Policy. If you cancel registration up to one week before camp there is a $40.00 Cancellation fee this is to cover the accounting and adminstration time . 6 days or less time you loss full payment as we will not be able to fill that space. If we cancel you recieve full refund.

Additional Comments:

Please include your 20% off membership code to recieve that discount here. Also if this is a gift with school code please place it here. Any all other extra information.

$30.00 Refundable Masterpieces pick up deposit (MPUD) will be paid to The Muddy Music Centre at time of registration. The deposit will be return in the form of a cheque within one week of picking up pieces. To qualify for your deposit you must pick up all your or children pottery or glass pieces with in the two week period that will be indicated by Muddy Music Centre Staff and also in writing on your pick up instruction. Which you must submit with your full name and mailing address at time of pick up to receive your MPUD. The MPUD has been added into the cost when you pay online. Please add it to cheques totals .

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Student Registration