Roaring Mouse Creative Arts Studio, LLC

Please Print This Page to Register

Name of Student  _________________________________________________________
Birthday
(if under 18)		  _________________________________________________________
Parent or Guardian   _________________________________________________________
Address   _________________________________________________________
City  ________________________   Zip_____________________________
Home Phone  ________________________   Cell Phone _______________________
E-mail Address  _________________________________________________________
Emergency Contact  ________________________   Emerg. Contact Phone ________________
Class (or Classes)  _________________________________________________________
  Person (other than parents) authorized to pick up child from Roaring Mouse:
  _________________________________________________________
Tuition Cost: ____________
Total Due: ____________

I agree for my child to receive instruction and to participate in the programs of Roaring Mouse Creative Arts Studio LLC. For and in consideration of my child's instruction and participation, I hereby release and hold harmless Roaring Mouse Creative Arts Studio LLC, its owners, agents and instructors from all claims and liability arising from my child's instruction and participation in Roaring Mouse Creative Arts Studio's programs.

Parent/Guardian Signature ___________________________________ Date __________

How did you hear about RMCAS ______________________________________________

I grant Roaring Mouse Creative Arts Studio, LLC, permission to use photographs of my student and/or my student's art work to promote the mission and programs of Roaring Mouse Creative Arts Studio in both print and electronic media.

Permission granted? (please circle one and initial):   Yes   No   ________________

checkbox Please check here if you are a new student or if your address has changed.

To register, please print and fill out this page. Enclose this registration form along with
your check, made payable to RMCAS, and mail to:

Roaring Mouse Creative Arts Studio (or RMCAS)    
PO Box 51139    
Seattle, WA 98115    

Thank you!

Note: Pre-payment is required. Classes will be filled on a first come-first served basis. Tuition will not be prorated or refunded due to absence. Full refunds will be granted for cancelled classes. A $10.00 handling fee will be deducted from tuition refunds if a student withdraws from a class. Registrations for afterschool and evening classes must be received two weeks prior to the start of class. Partial Scholarships are available. Call Lassie Webster at (206) 522-1187 for details.

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