Therapeutic Art Program Registration: Paint Cafe

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Full Name ( First / Last )

Email

Street Address

Name of Emergency Contact ( First / Last )

Your Age

Primary Phone

Town / City

Emergency Contact Number:

Select an option *

Resident of Noble Horizons

Non-Resident of Noble Horizons

Commute to the Art Class: *

I will drive myself

Someone (family/friends) will give me a ride

Noble Horizons will provide a ride

Art Learning Experiences

Never

K-12 School Art Classes

Adult Edu/Continuing Edu

Local Art Programs

Others

If your choice is "Other," Add answer here:

Why Would You Like to Take This Class?

How did you find out about us?

Thanks for your registration; We'll get back to you soon!

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Salisbury, CT 06068

Tel: 203-379-0015

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