Preregistration Form

To preregister for group classes, events or activities, please complete the preregistration form below and submit it to us.

We will call you within 24-48 hours (not including Mondays when we are closed) to confirm your preregistration.

If you would like us to call you, please check the ‘Phone’ contact option (at the bottom of the form) — or call us direct at 540-878-5701 to discuss your plans.

Simply complete the following form and send us your request:

(*denotes required field)

Name:*

E-Mail Address:*

E-Mail Address again:*

Please enter your E-mail Address a second time.

Phone number (Preferred number for us to call you):*

Alternate Phone Number:

Type of activity you are interested in? (Note: Please send a separate form for each if more than one - Thanks):*
Kids’ Summer Camps
Group Classes
Home Schoolers Classes/Parties/Trips
Girls’ Night Out
Office Party
Team Building Event
Boy Scout Troop/Merit Badge Classes
Girl Scout Troop/Merit Badge Classes
Fundraising Event
Other (outline in 'Additional Info' below)

What date(s) are you interested in coming? (Note: format mm/dd/yy - separated by commas if more than one)*

How many people will be in your group?*

Our group is:
All Kids (with parent/guardian)
Mix of Kids & Adults
All Adults

CHECK indicates that you have read & accepted any Earth Glaze & Fire policies relevant to your request:*

Questions? Comments? Additional information we should know:

How would you prefer to be contacted:*
Email
Phone

CAPTCHA Code:*

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