Child enrollment 2025 Winter sessionOne child per registration. Student Full Name * First Name Last Name Fall 2025 After school workshops * Monday Tuesday Centreville ES 12/10-2/25 | 8 weeks | $215 per child Tuesday Wednesday- Thursday Thursday Friday Inspired Teaching Demo | 8 weeks Parents Name * First Name Last Name Parent Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone contact 1 * (###) ### #### Student Information Child's age * 5 6 7 8 9 10 11 12 Child's Grade Level Birthdate * MM DD YYYY Disabilities * Special Needs * PAYMENT INFORMATION Cardholder's First & Last Name * First Name Last Name Card Type* VISA MASTERCARD DISCOVER AMERICAN EXPRESS Credit Card # Expiration Month Expirtation Year 3 Digit code for VISA, MASTERCARD & DISCOVER | 4 Digit code for AMEX * What is the zip code that this card belongs to? * Promo Code If you have a promo code, please enter it. Otherwise, hit Submit! Thank you! Your child is enrolled. You'll receive more info about the pottery class via email shortly. If you have any questions, email us at jimmy@jimmypotters.com. Thanks!
