Richard Abraham's

Summer Art Class Registration

Students Name _________________________________________ Age _________

Class Day _____________________________ Time/Times* __________________

Parent Name_________________________________________________________

Address ____________________________________________________________

City ____________________________________ State _______ Zip ___________

Home Phone __________________________ Cell Phone _____________________

Emergency Contact Name & Phone_______________________________________

Cost for 9 weeks  $160    Make checks payable to Richard Abraham

 Mail to: Richard Abraham       308 Prince St. #518       St. Paul, MN 55101

      * Students taking more than one class.