In Studio 2017 SC Registration

Parent's Name *
Parent's Name
Home Address *
Home Address
Phone Contact 1 *
Phone Contact 1
Phone Contact 2 *
Phone Contact 2
Camper's Information
Camper's Name *
Camper's Name
Birth Date *
Birth Date
Payment Information
Release of Liability/ Photo Release
I grant Jimmy Potters Studio & Workshop, the right to take photographs of my child and his/her work in connection with any Jimmy Potters Workshop class.I authorize Jimmy Potters, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Jimmy Potters Workshop may use such photographs of my child with or without their name and for any unlawful purpose, including for example such purposes as publicity, illustration, advertising and web content
Name *