CLASS  REGISTRATION

  Instructor:    

  Name:      

  If under 18, please enter student's age here:

  Mailing Address:
  
       
  Email:        

  Phone:           Cell:  

  Emergency Contact:      
                   
  Emergency Contact Phone:      

  How did you hear about this class?      

  Class Starting Date:          
   
  Class Time:    

  Request for Special Provisions/ Coments:
  
 
  The Arts Council, instructors, and volunteers will not be held responsible for any accidents or injuries that may occur. Please insert your initials to acknowledge.