Community School of Perfort Registration Form cspa@colburnschool.edu (213) 621-4548 | (213) 621-2110 fax Year Offa’ O spring O summer Arts COLBURN See SCHOOL ensuieny Ocaninigstdert “Ole Oemie Last Name: Fist Name: Birthdate: Address oi Ez Home phone:( ) cat ( ) mal: - School curently attendin - Current gadelevel: © Home Schoo!student Ifstudentis an adult, Employer: Employerphone:( ) ‘EMAIL for Bling Notices: Primary Contact Information _ ‘tHas information changed since last semester? Yes_NO last Name: First Name: OMe Ones. Os. Ode Relationship (mather/father/ete): cal ( ) mail Adress efferent from above): city State: 2p: Primary contact employer: Employerohone:( L Employer address: ity: State: Zi: dpm OMr OMrs, OMs. ODe last Name: Fist Name: Aatiorshipmather/fatherfote}: Cellohone:( ) Adress if torent fom above): city State: Zip: Employer shone: ( ) - ity: State: Zo Course Tile Day Time ain wWhs Instructor fee + Cone lasted inthe Shee ses Tuition Subtotal | Finder: finaiert Discount/Adust: Payment lan Fee: | Total Due: Fanent mustacompuny thisform, We acept recat an cheks made payable to COLBURN SCHOOL. unt Pai is iste ndr ae 8 pr or gndn mg yg a om ap tab te Sn Poe abe Arount Paes 2 nthe Cau Sb wee tcturaconad tnd wasongehneene leddedt ope a suloce: é B A Payments Remaining lg wm ‘Monthy Payment Amount:Community School of Performing Arts COLBURN Formulario de inscripcién SSS iF cspa@colburnschool.edu (213) 621-4548 | (213) 621-2110 fax senooe ml OO pinewera Ovens 0 SERIO crt O Mase Ofte Nombre: Fecha de nacimiento: Gudad: Tipe coi Email: Escuela actualmente astiendo Nivel de grado actual: “Informacién de contactoprindpat Appelido: Nombre: Ost OSra_Oor. Relacién (madre/padre/etc.): Gol ( ) Emal Direc ees aerente de aia) dads fade: 2p: Enpleador de coractoprincioa Taifonodeemsledor(—_) Direcén de enplende ciudad: Estado: ip Informacién de contactosecundaria ‘Appelido: Nombre: Ost Osra_Obr. Ielactin radre/parete): ot 1 Emi Direcién (ses erence de aria) Clad Esado: 2 inlet ide caine Telfonodeamplenor( —_) Direciénde enpenar: ciudad: sade: Zhe Course" course Dey Time Min #Wis Instructor fee “lon Sutra | FintisMer = : Finnie 3 Lol Discount/Adjus: ce eee hele bee ee al 3 Payment Plan Fe: <= Total be: Si sb want aod. an de cya ont SOL > Seb estudlante es menor de 28 afc, el padre o tutor debe firma. i frmar est formato, scesto cumplir com las Pliticas scores publcadas, Tas 2 nhc Cobn es amon Od ee Poymer Remaining: ig Firma fe = ‘Monthly Payment Amount: P