First Name:_______________________Last Name:____________________________________

Address:_______________________________________Apt.:___________________________

City:__________________________State:____________________________Zip:____________

Home Phone:______________________Email:_______________________________________

Cell phone: _____________________ Work Phone:___________________________________

Emergency Contact1___________________Relationship______EVE Phone:_______________

Emergency Contact 2__________________Relationship_______EVE Phone_______________

Monday – ceramics - $450 tuesday – painting - $450 wednesday – healing arts - $450 thursday – drawing - $450
	_______________________________________________________________
REGISTRATION FEE – required for all students	+$25.00
PAYMENT PLAN – 2 equal payments, paid by post-dated checks -$20 extra	+
MATERIALS FEE - Ceramics and Healing Arts ONLY	+35.00
TOTAL AMOUNT DUE upon first class

Total due is payable by personal check, cash or money order.

I understand and agree:

1. That payment of fees are for the Spring 2008 term and that I shall not be entitled to any deduction for my absences or illnesses during the term and that in the event of my withdrawal or suspension from the Program after classes have started, I shall not be entitled to any refund of unused tuition;
2. The AIAVAP calendar will follow the posted calendar on our website. Please refer to AIA VAP’s class schedule if you not sure if there will be class;
3. That if I am injured and require medical attention and the emergency contacts cannot be reached for instructions, I authorize AIAVAP to obtain emergency medical treatment for me with the understanding that the emergency contacts will be notified as soon as possible;
4. That AIAVAP reserves the right to modify the classes, change instructors or site as necessary, or to cancel the class not meeting enrollment;
5. That during the class, I may be photographed and/or videotaped by AIAVAP personnel or its authorized agents exclusively for internal and/or promotional use;
6. That my artwork produced during the AIAVAP classes, may be photocopied or copied using other methods to be used in publications and/or fundraising for AIAVAP without remuneration.
7. That in consideration of allowing me to participate in the AIAVAP program, I hereby release and forever discharge AIAVAP and Little Shop of Crafts and its officers, volunteers, employees, contractors and agents from any liability arising out of or based upon any bodily injury or property damage which may be sustained by me while participating in such program.
8. That I understand that Healing Art classes or workshops are not meant to take the place of traditional licensed psychotherapeutic modalities such as talk therapy or counseling, and it is recommended that those participating in Healing Art classes, workshops, or sessions seek counseling with a licensed psychotherapeutic practitioners if signs of clinical depression and or any mental distress is present.
9. I understand that the lessons or sessions I attended are not official training lessons or sessions, and techniques I have acquired while attending Healing Arts classes or workshops with Angela Tripi-Weiss and/or Arts in Action VAP Inc. are the sole property of Angela Tripi-Weiss and Arts In Action VAP Inc. and all rights to its name, curriculum, methodologies, and modalities are sole property of Angela Tripi-Weiss, and Arts In Action VAP Inc. I understand that no part of the Arts In Action VAP name, curriculum, or it’s methodologies and modalities can be used, recorded, video taped, filmed in any way, published, advertised, taught, practiced, duplicated, or copied in any form unless permission has been given by Angela Tripi-Weiss in writing.
10. Any or all concerns I have about the quality of the classes, lessons, or sessions I have enrolled in, the physical plant the class is conducted in, or its instructors, employees, or volunteers must be made in writing to the director of Arts In Action VAP Inc. before any changes or accommodations can be made by Arts In Action VAP Inc, employees, or volunteers.

Signature:_________________________________________Date:______________________

Printed Name:________________________________________________________________

Arts In Action Visual Art Program, Inc.™ (AIAVAP) is a non-profit 501c3 organization that provides a unique, sequentially-structured art education program using a visual language that all fine artists learn to communicate through. Since 1987, Angela Tripi-Weiss, Director of AIAVAP, has spearheaded non-profit art programs that empower children and adults. Ms. Tripi-Weiss, three-time Blackboard Award winner, has been called "one of the best visual educators and directors of art programming in Manhattan...a tour de force" and formerly directed Arts in Action at P.S. 87 in Manhattan for 18 years.

SPRING 2008 term: Mon., February 4, 2008 – Thursday, April 10, 2008

Arts in Action Visual Art Program, Inc. is a not-for-profit corporation (Fed. ID 56-2322737)

Classroom is located behind the Little Shop of Crafts, 94^th and Amsterdam Avenue, northeast corner

Arts in Action VAP, Inc. main phone: (212) 864-4883 or 917-363-4242 or artsinactionvap@aol.com

On-site phone at Little Shop of Crafts (for emergencies only): (212) 531-2723

Fees for 10 class sessions:

MONDAYS – Hand Building Pottery 10 CLASSES $450 - $60 materials and kiln fee required

TUESDAYS - Painting 10 CLASSES $450 Materials not included – list to be provided

WEDNESDAYS – Healing Arts 10 CLASSES $450 Materials included

THURSDAYS - Drawing 10 CLASSES $450 Materials not included – list to be provided

OTHER FEES:

Registration fee: $25 · Materials fee: $35 where applicable

Payment plan – 2 equal payments, paid by post-dated checks only at registration. $20

Returned check fee: $25

Arts in Action VAP, Inc. reserves the right to cancel any classes due to under enrollment.

Full refunds will be given and notice given before classes start on Feb. 4, 2008 if the class is cancelled.

*Contribute to Arts in Action VAP scholarship program for children! All donations are tax-deductible to the full extent of the law.

Email: artsinactionvap@aol.com · www.artsinactionvap.org