Live Arts Education Class Registration Form Spring 2020
Please fill out this form to complete your registration for Spring 2020 classes. Your registration is not complete until you have filled out this form and paid for the class.
Email address *
Name of student *
Your answer
Age of student *
Your answer
What school does the student attend (if applicable)? *
Your answer
Grade level (if applicable) *
Your answer
Please indicate what class you are registering for *
Check all that apply!
Required
Name of Parent or Guardian (if applicable) *
Your answer
Relationship to child (if applicable) *
Your answer
Home # *
Your answer
Work #
Your answer
Cell # *
Your answer
Email *
Your answer
Second Parent/Guardian Email or Alternate Contact Email
Your answer
Emergency Authorization and Consent for Live Arts Education Classes *
I, or I/We undersigned parents or legal guardians of the minor registered, do hereby give authorization and consent for medical treatment in the event myself, or my child, becomes ill or injured during a Live Arts class. Live Arts Staff or volunteers are authorized to take one or more of the following actions: a) provide reasonable basic first aid; b) release me or my child to the person listed below; c) take me or my child to a physician, or, d) take me my child to the hospital and/or give consent for emergency care.
Person in addition to parent or guardian or self to contact in emergency (and relationship to minor or self) *
Your answer
Home # *
Your answer
Work #
Your answer
Cell # *
Your answer
Do you or your child have any special needs, (behavioral, medical, emotional, etc.), we should be aware of to help you or your child have a safe and positive class experience?
*If you answered YES to the above question* (if you answered no to the above question, skip ahead) Education Director Miller Susen will contact you prior to your or your child's first class to discuss how we can best help you or your child to have a good experience at Live Arts. Please indicate below that you understand and agree to be contacted.
What would you, or your child, most like to get out of the Live Arts Education experience?
Your answer
How did you hear about Live Arts classes?
Your answer
PLEASE NOTE: Your place in class is not reserved without payment. Please make sure to pay for the class online at our website.
If you would like to arrange an alternative to paying online, please contact Miller Susen directly at miller@livearts.org.
Submit
Never submit passwords through Google Forms.
This form was created inside of Live Arts. Report Abuse