FALL 2005 CLASSES
Registration form

Please print and complete this form and send it with a check (payable to JMCA) or cc number to:
Kaleidoscope Program | Julia Morgan Center for the Arts | 2640 College Ave. | Berkeley, CA 94704

Student name: ___________________________________________________ Date of Birth: ___________________

Parent/Guardian Name:_______________________________________________________

Address:____________________________________________________________________________________________

City: ______________________________________________State: ______________Zip: ________________________

Day Phone: _____________________________________ Evening Phone: ___________________________________

Fax: ________________________________ Email: _________________________________________

Please put my child in the same class as: ____________________________________________________________

Enrolling in:

Class Title	Fee
Improv Jam	$120	$__________
Creative Dance	$80	$__________
Creative Drama - Wednesdays	$80	$__________
Creative Drama - Saturdays	$80	$__________
Acting Workshop	$120	$__________
Musical Theatre Workshop	$120	$__________
Total Class Fees:		$__________
Registration Fee (due once each calendar year)		$30
Credit Card Fee (if app.)		$12
Kaleidoscope Scholarship Donation (opt.)		$5
TOTAL ENCLOSED:		$__________

Credit Card: VISA  /  Mastercard       

Name on Credit Card: ___________________________________________________________

Authorized Signature: ___________________________________________________________

Credit Card #: _____________________________________________ Exp: ________________

PHOTO RELEASE: I grant permission to the Julia Morgan Center for the Arts to use photographs taken of me for use on the JMCA web site or other media without notifying me.

Signed: _______________________________________________________________