In order to make registration for classes easier, you can opt to complete this page on-
line, so that I have the information. Then, forward payment for the classes to Immaculate
Conception school office or to Mrs. Elena Cipolla 360 Wellington Terrace Jenkintown, PA
19046. Please note that you do not have to be an Immaculate Conception student to
enroll!

All registrations for the Winter I classes should be completed by Friday December 19th,
so that supplies can be ordered. Classes start for Winter I on Saturday, January 9th.

• 1) Student name
  Answer:
• 2) Student grade/age:
  Answer:
• 3) Select the course you are registering for:
  

  Beginning (all first year students)
  Advanced class: Portraiture I
• 4) Please list an emergency contact name and phone number
  Answer:
• 5) Please enter Health coverage information (Name/Group #)
  Answer:
• 6) If you have any questions, please note them below. I will get back to you as soon as
  possible.
  
• 7) Email address:
  Answer:
• 8) Please enter your email address:
  Answer: