Child enrollment 2025 Fall sessionOne child per registration. Student Full Name * First Name Last Name Fall 2025 ASEP Registration * GREENBRIAR EAST ELEM -SOLD OUT Monday | Tuesday | Candlewood ES | 9/9-11/4 | 8 wks | $235 Thursday | Cloverly ES | 10-9-12/4 | 8 wks | $235 Thursday | Franconia ES | 10/9-12/4 | 8 wks| $235 Friday | Fields Road ES | 10/3- 12/12 |8 wks | $235 Friday | Inspired Teaching | 9/12- 11/21 | 10 wks | $295 Parents Name * First Name Last Name Parent Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone contact 1 * (###) ### #### Student Information Name of your child's homeroom teacher? Child's age * 5 6 7 8 9 10 11 12 Child's Grade Level Birthdate * MM DD YYYY Disabilities * Special Needs * PAYMENT INFORMATION Cardholder's First & Last Name * First Name Last Name Card Type* VISA MASTERCARD DISCOVER AMERICAN EXPRESS Credit Card # Expiration Month Expirtation Year 3 Digit code for VISA, MASTERCARD & DISCOVER | 4 Digit code for AMEX * What is the zip code that this card belongs to? * Child dismissal Parent/Guardian Pick up Walk Home After-school care Promo Code If you have a promo code, please enter it. Otherwise, hit Submit! Thank you! Your child is enrolled. You'll receive more info about the pottery class via email shortly. If you have any questions, email us at jimmy@jimmypotters.com. Thanks!
