Kuumba Institute Summer Registration Form
Registration fee is $50 and applies to each child registered.
Tuition: One child - $400.00; Two children - $500; Three children - $600; Four children - $700.
Save $50 off TOTAL registration if paid by May 6, 2019.

SUBMIT ONE FORM FOR EACH CHILD.
If you are paying for more than one child, PAY ONLINE ONLY AFTER ALL REGISTRATION FORMS HAVE BEEN COMPLETED AND SUBMITTED.
(1) Go to www.ashecac.org. (2) Click the "Donate" button. (3) Enter the total amount. (4) CHOOSE: Donate with a debit or credit card. (5) Click on "Add special instructions to the seller," then (6) ADD THE NAME(S) of the child or children you are registering. (7) Complete your transaction.

Email address *
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Address
Your answer
City, State, Zip Code *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Child's School *
Your answer
Grade Level *
Race *
Your answer
Date of Birth *
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Gender *
Age *
T-Shirt Size *
Parent's/Guardian's Full Name *
Your answer
Parent's/Guardian's Phone Number *
Your answer
Emergency Contact's Name *
Your answer
Emergency Contact's Phone Number *
Your answer
List any medical issues, such as ALLERGIES, or any other conditions particular to your child that the staff needs to know. (If none, enter not applicable) *
Your answer
Family annual household income: *
Your answer
Number of people living in household: *
Parental permission to use photos, film or any likeness of your child for promotional purposes for Ashé Cultural Arts Center only. *
Today's Date *
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