Registration Form
Fall 2018 Dairy Barn Classes and Workshops
Class or Workshop Catalog Number *
Please enter as it appears on the website . Do not include # or words. Example: A019.
Your answer
Class or Workshop Title *
(Please enter as it appears on the website to ensure proper processing of your registration)
Your answer
Your Last Name *
Your answer
Your First Name *
Your answer
Class or Workshop Start Date
EX: 10.31.16
Your answer
Your Email Address *
Your answer
Phone *
Please enter as such: 740.592.4981
Your answer
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 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
Parent/Guardian Phone
Your answer
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