2008 Tomato Patch Registration Form
Please print this form, and mail the completed form with payment to:
Tomato Patch 2008
Mercer County Community College
P.O. Box B
Trenton, NJ 08690
You will receive more information and a course selection form by return
mail.
All courses are filled on a first come / first served basis.
| Student's
Last name |
Student's
First name |
| Parent/Guardian's
Last name |
Parent/Guardian's
First name |
| Street | Home phone |
| City | Best time to call home phone |
| State & Zip | Work phone |
| e-mail address | t-shirt size (adult sizes) |
| ____ Male ____ Female | Age | Grade in fall 2008 |
| Have you attended Tomato Patch in the past? ___ No ___ Yes, in _______ |
Circle the Desired Dates and Tomato Patch Choice
| Dates | For Grades | Tomato Patch Choice | Tuition |
| June 23-July 17 (Session 1) | 8-12 | Visual Arts emphasis | $625 |
| June 23-July 17 (Session 1) | 8-12 | Performing Arts emphasis | $625 |
| July 21-August 7 (Session II) | 5-7 | Visual Arts emphasis | $525 |
| July 21-August 7 (Session II) | 5-7 | Performing Arts emphasis | $525 |
| July 21-August 8 (Session II) | 8-12** | Performing Arts Master Class** | $475 |
| Total Tuition for All Circled Tomato Patch Choices | $ | ||
| Non-refundable application fee that must accompany this form | + $25 | ||
| Total Registration Cost | |||
**Participants must have attended or be signed up for Session 1, TP On & Off Screen or had other formal theater training.
I give Mercer County Community College consent to use the name and/or photograph of the above registered camper for inclusion in promotional materials related to "Tomato Patch". These include and are not limited to newspaper, television and brochures. I waive the right to approve such issues and I release Mercer County Community College from any and all liability should any occur.
Signature of Parent/Guardian____________________________________________
Payment
You may pay by check or by Visa or MasterCard. NOTE: You must pay the $25 non-refundable application fee with this application. You may also pay the total tuition now or when you submit the completed course selection form. Tuition now includes t-shirt, Pizza Party on performance dates, 2 tickets for each performance and DVD of art exhibit and festival.
| ___ I will pay only the $25 registration fee now and pay the tuition of $ _______ with the course selection form. OR |
| ___ I will pay the total registration cost now. |
Method of Payment
| ___ Check payable to Tomato Patch/MCCC. Include the student's name on the check or money order. OR | |||||||
| Charge to: | ___Visa
___Mastercard ___Amex |
||||||
| Card
Number |
3 Digit Code
on back of card |
Expiration
Date |
| Cardholder's
Name |
Cardholder's
Signature |
|
Tomato Patch is funded in part by The Mercer County Cultural and Heritage Commission
and the NJ State Council on the Arts/Department of State
