Karamu Arts Education Registration
JANUARY 26TH, 2019 - MAY 11TH, 2019

Registration for enrollment in the Karamu Arts Education programming. 1 - 2 members of the same household can attend classes for $25 a week. If you have any questions or concerns when completing your registration do not hesitate to contact Latecia Wilson, Arts Education Manager, at 216.795.7070, ext 2, 1. Spring 2019 Enrollment is open until March 9th, 2018.

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Participant 1: First & Last Name *
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Participant 1 Date of Birth *
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Participant 2: First & Last Name
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Participant 2 Date of Birth
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School and Current Grade of Participant 1
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School and Current Grade of Participant 2
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Street Address *
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City, State *
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Zipcode *
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Home Phone Number *
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Cell Phone Number
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Participant 1: Gender
Participant 2: Gender *
Email Address *
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Class Selections
Please select the classes in which you and/or your youth participants(s) will attend this session.
Saturday Youth Academy *
Required
Rehearsal Times *
Required
Adult Class Options *
Required
Allergies or Dietary Restrictions
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Disabilities or IEP
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Medications
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1st Emergency Contact
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Emergency Contact Relationship
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Emergency Contact Number
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2nd Emergency Contact
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Emergency Contact Relationship
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Emergency Contact Number
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Parent/Adult Participant Signature
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Today's Date
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