! ! REGISTRATION FORM Student`s name Date: Gender: M or F If

!
REGISTRATION FORM
!
Please enclose payment and mail to: Munroe Center for the Arts, 1403 Massachusetts Avenue, Lexington, MA 02420
You may also register by PHONE by calling 781.862.6040, FAX your registration to 781.674.2787, ONLINE at
www.munroecenter.com.
Student’s name
Date:
Gender: M or F If under 18: Date of Birth
Grade
School
Parent/Guardian’s name
If you have previously taken a class through Artspan, please check here 
Address
Town/city
State
Home phone (
)
Cell/Work phone (
Zip
)
E-mail address
 Yes, I agree to allow Artspan to take and use photographs, slides, and recordings of myself and/or my child for
records or public relations.
Student or Parent/Guardian Signature (if under 18)
COURSE#
COURSE – VACATION
ARTS – WORKSHOP
Day &Time
Tuition
Materials/
Extended
Day Fee
REQUIRED: BUILDING RESTORATION FEE. $35/per student $75 max/per family. Paid once
annually –academic year September – August. Waived if paid to another Munroe School
(Circle): Dance Inn - Lexington School of Ballet - Lexington Music School
SUBTOTAL
Circle Fee:
$35 – $70 - $75
Already Paid
TOTAL TUITION/EXTENDED DAY & MATERIALS FEES/BRF TOTAL
Payment by: Cash Check Visa Mastercard Card #
Cardholder’s name
Signature
Exp. Date
CSC/CVV (3 digit code on back of card)