Fall sign up 2011

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Please print this form and return to Stiller Zusman 409 West Seneca St., Ithaca, NY 14850

Call Stiller for more information 607-262-6562. Your child's name ______________

Abovoagogo Fall 2011 Art Classes

Art Jump Start | ages 2-4, Thursdays 10 - 12.

___________$23 / class | $200/10 classes. Starts Sept 8th

Tuesday Afternoon Studio Workshop | ages 7 and up, Tuesdays 2:30 - 4.

___________$170 /15 Classes form Sept 13th - Dec 20th

Teen Studio Workshop| middle school age and up, Tuesdays 4:30 - 6:00

___________$170 /15 Classes form Sept 13th - Dec 20th

Agogo Afternoon: ages 4 - 6, Thursdays 2:30 - 4.

___________$17.00/class, $230/ series of 14 classes from Sept 15th - Dec 22nd.

Wednesday Drawing Like Crazy | ages 6 and up, 2:30 - 4:00.

___________$ 17.00/class $200.00/ for the series of 12 classes from Sept 16th - December 18th.

Fridays Drawing Like Crazy | ages 6 and up, 2:30 - 4:00.

___________$ 17.00/class $200.00/ for the series of 12 classes from Sept 16th - December 18th.

Photo I | ages 6 and up, Mondays from 2:30 - 4:00.

___________$ 170.00 for 10 Sessions from September 12th - November 28th.

Photo II | ages 6 and up, Tuesdays from 4:00 - 5:30

___________$ 170.00 for 10 Sessions from September 13th - November 29th.

Total_________________________

Please make checks payable to: Abovoagogo

Abovoagogo Permissions and Medical Information

Your Name_______________________________Child's Name_____________________________

Age____________

Address___________________________________________________________________________

Phone Numbers: (Home)__________________________(cell)_________________(other)________

E-mail_____________________________________________________________________________

Medical Alerts: (allergies, injury, impairments)___________________________________________

__________________________________________________________________________________

Doctor’s name and phone___________________________________________________________

I ______________________________ release Stiller Zusman and Gwen Bullock from all liability while my child is in their care and I give them permission to seek medical assistance for my child.

I do ( ) do not ( ) give permission for my child to be photographed for publicity and/or documentation.

( ) Check here if you will be dropping your child off at 409 West Seneca Street.

( ) Check here if your child will be picked up from BJM school by Gwen or Stiller at 2:00pm.

( ) Check here if your child is in the Monday Photo Class.

Drop off is at 2:30 at Abovoagogo Studio.
Pick -up is at Village at Ithaca 4:00pm.

( ) Check here if your child is in the Tuesday Photo Class. 4:00 - 5:30 pm.
Drop off and pick-up at Village at Ithaca:
609 W Clinton St # 109
Ithaca, NY 14850-5255
(607) 256-0780

My child will be picked up by___________________________________________________________

Signature____________________________________________________________Date____________

Notes:_______________________________________________________________________________

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