SUMMER 2004 KALEIDOSCOPE UNLIMITED
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: ____________________________________________________________

How did you find out about the Kaleidoscope program?
(please mark all that apply)
____ Attended Productions at JMCA     ____ Called to request brochure       ____ From a friend
____Internet            Other/Please specify: _________________________________________________

Enrolling in:

Class Title		Fee
Kaleidoscope Unlimited	August 16 - 27	$575	$__________
	Registration Fee (due each calendar year)	$25	$__________
	Credit Card Fee	$12	$__________
	Would you like to donate $5 to the Kaleidoscope Scholarship Fund?	$5	$__________
	$25 discount if returning student	(-$25)
	TOTAL ENCLOSED:		$__________

*minimum age 4 years

Credit Card: VISA  /  Mastercard

Name on Credit Card: ___________________________________________________________

Credit Card #: ____________________________________________________________________

Exp: ________________