(optional)

Class Selected:

Section:

Instructor:

Day(s)/Time:

Tuition:

Lab/Materials Fee:

Total:

   
(optional)

Class Selected:

Section:

Instructor:

Day(s)/Time:

Tuition:

Lab/Materials Fee:

Total:

Your Information:

(mandatory)

Students Name :

If child, parent name:

E-Mail Address:

Phone:

Address:

City:

State:

Select US State Alabama Alaska Arizona Arkansas California Colorado Connecticut District Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip: 

Emergency Contact Name and Phone:

Medical Release/Permission Form:
In the event that my/my child's photo is taken I hereby give permission for Wesleyan Potters to use said photos in promotional literature, including but not limited to brochures and flyers. I understand and agree that some of the programs at Wesleyan Potters can be physically demanding but, I feel that I/my child has the physical ability needed to participate. In the event of an emergency I hereby give permission for myself/my child to be transported to the Middlesex Hospital or any other nearby medical facility. It is hereby understood and I agree that I shall assume full financial responsibility for any costs over and above that which is not covered by my health insurance. To the fullest extent permitted by law, I agree to indemnify and hold harmless Wesleyan Potters, Inc. and it's employees from any injuries or damages caused by or resulting from participation in this program. I have also read, understand and agree to the conditions of the refund policy outlined above. A photostatic copy of this waiver shall be considered as valid as the original.

____________________________________________
(Participant's Signature OR Parent/Legal Guardian Signature if under 18)

Payment Information:

Check is enclosed. Check #

Cash is enclosed.

I will be paying with a Credit Card:

Card Number:
Expiration Date: /
CSV Number on back of card:
Name on Card:
Billing Zip Code:

To register for summer classes or workshops, please mail or drop off the registration form below with full tuition and fees. Cash or checks only. Please refer to the calendar below for important dates and deadlines.

To register, complete this form and send this form with payment to:
Wesleyan Potters, 350 South Main St., Middletown, CT 06457

Office hours: weekdays, 9 a.m. - 3 p.m.
Telephone: (860) 347-5925
E-mail: wesleyan.potters@snet.net
Please make checks payable to: Wesleyan Potters

Registration calendar:

NOW - May 7 Submit a completed registration form with full payment or a scholarship application to be eligible for the lottery.

May 8, 9 a.m. Summer registration lottery is run.

May 9, 12 p.m. If a class is oversubscribed, students who are wait listed for their 1st choice class will be notified by telephone or email.

May 9 through June 4 Registration will be accepted on a first come, first served basis for remaining spaces in summer classes.

June 4 Summer semester begins.

Refunds: The Pottery will retain a $20 processing fee for all refunds on classes that are held as scheduled. Tuition fees can be refunded if the student withdraws prior to two weeks before the beginning of classes, but the processing fee is not refundable. Thereafter, a refund for a student cancellation will be made only if the place the student holds in the class can be filled. Sorry, there are no refunds once a class has started. This includes absences due to unexpected events or personal circumstances such as illness. Any deviation from Pottery rules may result in dismissal from class with no refund. Students are responsible for their own health and safety. The Pottery reserves the right to change instructors or cancel courses as necessary. For classes cancelled due to weather or instructor illness a make-up time will be scheduled. If in doubt of weather cancellations, call the office.