Custom Class Payment Custom Class Payment form for reduced classes, or gift card remainders. Please fill out the following information. Student's Name* First Last Age*Student's Email* Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Class Being Registered for:* Reson for Needing a Custom Payment* Permissions for Participation*--I hereby give my permission to participate inWoodstock Arts Classes. --I do also release Woodstock Arts Board Members, Staff and Instructors from any and all liability due to an accident, injury, or exposure to illness that may result from participation in the classes. --I consent for photographs to be taken for press releases that may include name, age and city of residence. --I understand that there is a non-refundable deposit of $50. --I understand that due to the unusual circumstances we are in, that Elm Street has the right to cancel and/or postpone this class at any given time due to Executive Orders made by the State or at the discretion of the organization. Permission/Release GrantedPrice* TotalPlease check this prior to checkout. Your final total may be inaccurate due to an accidental autofill from your address or phone number. $0.00 Credit Card*