2010 Tomato Patch Registration Form
Please print this form, and mail the completed form with payment to:
Tomato Patch 2010
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 2010 |
| 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 28-July 22 (Session 1) | 8-12 | Visual Arts emphasis | $650 |
| June 28-July 22 (Session 1) | 8-12 | Performing Arts or TV emphasis | $650 |
| July 26-August 12 (Session II) | 5-7 | Visual Arts emphasis | $550 |
| July 26-August 12 (Session II) | 5-7 | Performing Arts or TV emphasis | $550 |
| July 26-August 12 (Session II) | 8-12** | Performing Arts Master Class** | $500 |
| 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 or had other formal theater training.
I hereby give permission for student to attend Mercer County Community College’s Tomato Patch Workshops, subject to the authority of Tomato Patch Director and Staff. I agree not to hold the college or staff responsible for loss of money, jewelry, or personal articles brought to workshops by student. I also give permission for the use of any photograph of the student to be used in MCCC public relations. I affirm that all personal and health information regarding the student provided to the college is true and correct to the best of my knowledge.
Signature of Parent or Guardian________________________________Date_____________________
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. (T-shirt and DVD not included in Master Class)
| ___ 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
