xRegistration Form

Please select your classes by placing them in your shopping cart. Please fill out the registration form FIRST. Once this information is COMPLETE and SENT, then you may proceed to make your payment via paypal using the shopping cart checkout button on the right.

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Student(s) First and Last Name

Student(s) Date of Birth/Grade

Program(s) Selected (required)

Parent Name

Your Email (required)

Address, City State Zip

Phone (required)

Cell Phone (required)

Emergency Contact & phone #

How Did You Hear About Us?

Payment via Zelle

-payment made via Zelle (201-341-7714)Check payable to Bass Arts Studio mailed to: 202 Park St. Montclair, NJ 07042-

Tuition Amount Paid

Photo Release: Bass Arts Studio DOES/DOES NOT have my permission to use photos of my child for publicity.

YESNO

I/ we the parents of the above named child do hereby give my/our approval to participation in any and all of the activities. I/We do assume all risks andhazards incidental to the conduct of the activities and transportation to and from activities; and do further hereby release, absolve, indemnify and hold harmless Bass Arts Studio and the organizers and supervisors, any or all of them. In case of injury to my/our child, I/we hereby waive all claims against theorganizers, the sponsors or any supervisors appointed by them.

YESNO

Comments & Concerns or special needs (allergies)

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