STUDENT'S NAME: ________________________________________


STUDENT’S AGE  (if a child)________  Female ___  Male ___


PARENT NAME(if enrolling child)_____________________________


ADDRESS:_______________________________________________


PHONE: (H)______________________ (C)_______________________

E-MAIL____________________________________________________


TOTAL ENCLOSED:  __________________ 
$32 for each 2-hour class

Please make checks payable to: Demetra McMullan
Mail to:  21333 Thimbleweed Court, Ashburn  VA  20147

Client assumes all risks involved.  Client hereby acknowledges that he/she proceeds at their own risk, and indemnifies and holds harmless Demetra McMullan, for any injury, act, or liability that occurs to the client or his/her family as a result of the use of the services and premises provided.

I understand and agree to the above conditions.


Name___________________________________

Date_____________________

Please choose from the following options:
Some photographs taken at NOVA Sewing Studio may be used for promotional purposes, on the website, or any other printed media hereon.

OK to use photos _____________

NOT OK to use photos ______________