The following application form may be completed on-line or can be printed and mailed in to the school.

__      _  _  _  _  _  _  _  _  _  _  _  _      _       _      _  ___________________________________                    ___ Lexington   ___ Marlboro ___ Washington

               Full name of student

_______________________________________ (Mailing address, including zip code)

Child’s t-shirt size (check choice) Children’s sizes __S (6-8) __M(10-12) __ L(14-16); Adult __ S __ M __ L

_____ I have completed the Emergency Medical Form on the next page.  (this must be printed for signature)

_____ My child’s photo may appear:  ___ newspaper ___ print campaign ___ website

___________________________________________________

     Name of parent/guardianHome phone number

Please circle the course and place a check on the line next to the desired times/class*.

9:00 – 10:00___Pottery, Visual Art, Guitar Class**

10:00- 11:00___Pottery, Visual Art, Guitar Class** Beginning Violin I **(ages 6, 7, 8)

11:00 – 12:00___Photography, Sculpture**, Guitar Class**, Violin I** (ages 9, 10, 11)

Dance

12:00 – 12:30___Lunch (Students may pack lunches if they have morning and afternoon classes)

12:30 -  1:30 ___Theatre, Dance, Guitar Class**, Sculpture**, Intermediate Violin**,

Pottery, Children’s Chorus, Visual Art, Photography,

1:30   -  2:30 ___African Drumming, Comics Creation, Theatre,  Hand bell choir**

All courses and times may be subject to change based on registration and availability of instructors. Sections may also be added if the demand for a certain course is greater than that section can accommodate.

Sculpture, and Photography will be limited to 10 students, Hand Bell Choir to 10 and Guitar Class to 8 students.   Other classes will be limited to 12 students to insure quality instruction.

*  Underline class if unable to check line on your computer.

* * * RETURN TO SCHOOL OFFICE * * *