Registration Form 2008-2009

Parent Name  

Address 

City, State, Zip

Phone #

E-mail

Please list children to be registered:

    Name                                                                      Date of Birth

 _______________________                                                                  ___________

 

_______________________                                                                   ___________

 

_______________________                                                                   ___________

 

_______________________                                                                   ___________

 

Submit application via mail to: 

 

Cathy Glass, 3005 Ironworks Pike, Georgetown, KY 40324 or email application

 

to pottersvessel@juno.com  If you have any questions, please contact me via

 

e-mail or at 502-863-0989.