Mail To: Fiddlehead Center for the Arts - FiddleStarts Registration, 25 Shaker Rd P.O. Box 1689 Gray, Maine 04039

Student's Name	.
Birth Date and Age	.
Allergies and or Conditions	.
Parent's Name	.
Address	.
City	.
State/Zip	.
Home Phone	.
Work or Cell Phone	.
Email Address	.
Emergency Contact	.
Emergency Phone	.

Scheduling, Tuition and Fees for FiddleStarts 2006-2007: Classes are available: (5 days) Monday-Friday or (3 days) Monday/Wednesday/Friday for 4-5 year olds and (2 days) Tues & Thurs for 3 year olds. Classes run for a total of 36 weeks per year. Non-refundable application fee: $40.00 (if enrolling more than one child add additional $20 per child). The initial payment: Equivalent of one month (see options below) is due upon registration along with the non-refundable application fee. Payments thereafter will be made quarterly (first quarter’s balance due by July 15 then Oct/Jan/Apr) or annually (balance due by Aug 15) using checks or credit cards, or monthly using credit cards only (charged automatically to your credit card on the 15th of every month from Sept through April). Refund Policy: If applicant withdraws less than 60 days from the first class or during the school year, the early withdrawal penalty will be the equivalent of a one month payment plus the application fee. (Any other monies will be refunded – i.e. if you made a quarterly payment, etc.) If applicant withdraws 60 days or more before the first class, the first month registration payment/deposit will be returned, however, the application fee will not be returned.

Please circle your choices:

Morning Classes (8:30 a.m. - 11:30 a.m.)	Afternoon Classes (12:30 p.m. - 3:30 p.m.)	Cost and Payment Options Monthly*    Bimonthly  Annual
Monday - Wednesday - Friday	Monday - Wednesday - Friday	$252/mo*          $454         $2160
Tuesday and Thursday	Tuesday and Thursday	$168/mo*          $302         $1512
Full day - Monday - Wednesday - Friday		$504/mo*          $908         $4536
Full day - Tues/Thurs 8:30 a.m. — 3:30 p.m.		$336/mo*          $605         $3024
*Credit Card Payments Only

TOTAL REGISTRATION COST:	$_______________	+   $_______________	=   $_______________
	1st Month or more	Registration Fee	Total Cost

Check enclosed      Credit Card

Card Type: __________________     Card Number: ______________________________     Expires: _________________

Name as it appears on card: ________________________________________________

Photo Permission & Liability Disclaimer: I ( do / do not ) give permission for my child’s photograph to be taken and posted, used for publicity, and/or posted on our website. Fiddlehead Center for the Arts and its instructors are not liable for personal injury or loss or damage to personal property.

SIGNATURE: ________________________________________________    DATE: _________________________________