Winter 2019 Youth Classes/Workshops Registration Form
Class Catalog # *
On website, please list as capital letter and numbers Ex: A005
Your answer
Student First Name *
Your answer
Student Last Name *
Your answer
Student Age *
list as number (Ex:5)
Your answer
Parent Name *
Your answer
Cell Phone *
Your answer
Home Phone
Your answer
Email *
Your answer
Acknowledgment: I give permission for my child to attend this Dairy Barn class or workshop. I have reviewed all the available online information regarding this class. I will bring my child in clothing that can get dirty or stained. I understand that this is a classroom setting and that parents may not be allowed to stay in the classroom. I understand that if my child is unable to be in class without a parent, (not applicable for #A081 Preschool Art Class with Parent) that they may not be ready to take this class. I will talk to my child before class about how to behave in a classroom setting. I will retrieve my child from class within five minutes of it's ending. I understand that if I choose to leave the Dairy Barn during my child's class, that the teacher must be informed of that and have my cell phone number on hand. *
The Dairy Barn welcomes children of all abilities. If your child has specific needs we should be aware of, please tell us below. Feel free to contact the teacher to discuss any questions or concerns you may have. (Email
Your answer
In case of injury or Illness:
By clicking the accept box, I state that 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.
Photography Release
The Dairy Barn respects your parental rights! We love publicity, but we understand not all parents are comfortable having their children’s photos published. Photographs may be taken by Dairy Barn staff and used on the Dairy Barn website, Facebook page, or in teachers personal portfolios or personal social media pages. Photos may also be taken by local news media and used in newspapers and on their websites. If you want to allow photos of your child to be used, click "Allow". If you do NOT wish you camper to be photographed, click "Don't Allow"
How would you like to submit payment for this class *
Please let us know how you want to submit payment. If you would like to postpone payment until the class or workshop has been confirmed to run, select "Pay in Person". Once the class or workshop has enough participants to be viable you will receive an email asking to submit payment to further reserve your space.
Refund Policy *
The Dairy Barn Arts Center does not issue refunds for classes and workshops unless said class or workshop is cancelled by the Dairy Barn. If a class or workshop is cancelled by the Dairy Barn, you may either request a refund, or have your payment credited to future events such as classes, workshops, or camps.
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