About Your Organization

Organization Name

Organization Street Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization Type

PTA

PTO

Private School

Religious Organization

About You

After-school contact name

First Name

Last Name

Your title/role in the organization

After-school email

Phone

(###)

###

####

Your program request

How many weeks would you like to offer pottery?

6 weeks / $195 per child/ all materials included

8 weeks / $225 per child/all materials included

9 weeks /$255 per child/all materials included

10 weeks /$285 per child/all materials included

Where will the pottery class be held in your school? (i.e. Art room, Gym, Class Pod)

What time would you like pottery to start and end? ( i.e. 3:15pm-4:15pm)

What day would you like to offer pottery?

List all the dates pottery will be offered (i.e. 1/4, 1/8, 1/12, 1/15, 1/18, 1/21)

Will there be any holidays or teacher workdays during the pottery session? If yes, please list the date(s)