Merrick Art Gallery

1100 Fifth Avenue
New Brighton, PA 15066
ph: 724-846-1130
merrickartgallery@verizon.net

Class Registration

*First Name of Student:

*Last Name of Student:

Address Line 1:

Address Line 2:

City:

State/Province:

ZIP/Postal Code:

*Class(es) enrolling for:

*Email:

*Phone:

Name of Parent or Guardian:

Notes:
Please notify if someone other than named above is picking up the child.
List additional Children if necessary.

Submit Your Message:

1100 Fifth Avenue
New Brighton, PA 15066
ph: 724-846-1130
merrickartgallery@verizon.net