Dairy Barn Classes and Workshops Online Registration Form
Class or Workshop Title
(Please enter as it appears on the website to ensure proper processing of your registraion)
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Class or Workshop Catalog Number
Please enter as it appears on the website to ensure proper processing of your registration. If registering for multiple individual workshops in the same series for a group rate, please list the catalog number with the first #, then a dash - and the last number, for example B010-B014
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Your Last Name
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Your First Name
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Class or Workshop Start Date
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Your Email Address
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Street Address
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City
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Zip Code
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Phone
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Are you a Dairy Barn Member?
Required
Are you over 18?
Required
Payment Options
Please let us know how you want to submit payment
For participants under the age of 18: I (name below) as the participant's legal guardian give permission for my child to participate in this Dairy Barn workshop or class and corresponding activities. In case of accident or serious illness, I request that I/we be contacted. I give permission for emergency medical treatment and to be transferred to the nearest medical facility. I agree to assume all costs related to such treatment and I release the Dairy Barn from any responsibility for injury or illness that may occur while my child participates. I understand that typing my name below constitutes my legal signature.
Type your full name in the box below with the date.
Your answer
For persons participating in child/guardian activities (such as the Infant Expressions series) I understand that my child is to be under guardian supervision at all times during the activity. I understand that I am responsible for his or her safety, and that I or another guardian are to remain with the child at all times. I understand that typing my name below constitutes my legal signature.
Type your full name in the box below with the date.
Your answer
Parent/Guardian Phone
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Would you like to receive our newsletter with information about the Barn and future classes and workshops?
If you are a member, or you are already on or mailing list, check no
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