REGISTRATION FORM

Please use this form to register for The Studio School. After you submit this form, you will be directed to the online payment system, where you can pay your fees with a credit card (VISA, MC or Discover) or by electronic check.

Complete and submit this form for each child.

If you prefer to register and pay by phone, please call 707-826-3731.

Child Information

= Required field

Child's First Name

Child's MI

Child's Last Name

Select child's gender identity:*

Male

Female

Other

Decline to state

Has your child ever been enrolled at Cal Poly Humboldt?

YES

NO

Your child's date of birth is required so that Cal Poly Humboldt may identify records that are unique to the child.

Month:
Day:

Year (4 DIGIT):

Parent/Guardian Information

= Required field

First Name

MI

Last Name

E-mail

Mailing Address

Mailing Address Line 2

City

State/Province/Region

Country

ZIP/Postal Code

Daytime Telephone (include area code)

Mobile Telephone (include area code)

Session Registration

Check the session(s) your child will attend.

Session 1: Ages 5-13 - Registration closed

Animal Kingdom
Sat., Sept. 21-Oct. 19 • 9 a.m.-12 p.m., $185
$

Before/After Studio School Program: Session 1
Optional. Mon.-Fri., July 15-19, 8-9 a.m./3-5 p.m., $135
$

Session 2: Ages 5-13 FEE

Artful Adventures
Sat., Oct. 26-Nov. 23 • 9 a.m.-12 p.m., $185
$

Before/After Studio School Program: Session 2
Optional. Mon.-Fri., July 22-26, 8-9 a.m./3-5 p.m., $135
$

Session 3: Ages 5-13 FEE

Palette of Possibilities: Discovering the Art of Painting (Ages 5-13)
Mon.-Fri., July 29-Aug. 2 • 9 a.m.-3 p.m., $300

$

Before/After Studio School Program: Session 3
Optional. Mon.-Fri., July 29-Aug. 2, 8-9 a.m./3-5 p.m., $135

$

TOTAL FEES
You will enter your payment information after submitting this form. $

Submit the form

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Please review the above information for accuracy before submitting this registration form.

Once you submit the form successfully, you will be directed to the payment system.

Check the session(s) your child will attend.
Session 1: Ages 5-13 - Registration closed
Animal Kingdom Sat., Sept. 21-Oct. 19 • 9 a.m.-12 p.m., $185	$
Before/After Studio School Program: Session 1 Optional. Mon.-Fri., July 15-19, 8-9 a.m./3-5 p.m., $135	$
Session 2: Ages 5-13	FEE
Artful Adventures Sat., Oct. 26-Nov. 23 • 9 a.m.-12 p.m., $185	$
Before/After Studio School Program: Session 2 Optional. Mon.-Fri., July 22-26, 8-9 a.m./3-5 p.m., $135	$
Session 3: Ages 5-13	FEE
Palette of Possibilities: Discovering the Art of Painting (Ages 5-13) Mon.-Fri., July 29-Aug. 2 • 9 a.m.-3 p.m., $300	$
Before/After Studio School Program: Session 3 Optional. Mon.-Fri., July 29-Aug. 2, 8-9 a.m./3-5 p.m., $135	$
TOTAL FEES You will enter your payment information after submitting this form.	$