After School Arts Program Registration
All ASAP classes are free and held at the Tippecanoe Arts Federation unless otherwise noted.

Parents: please note that students must be able to commit to 100% attendance at ALL sessions of the class in which they enroll.

If you need assistance completing this form please email coo@tippecanoearts.org or call (765) 423-2787.

Student Information
Student First Name *
Your answer
Student Last Name *
Your answer
Student Street Address *
Your answer
City, State, ZIP *
Your answer
Student's Grade Level *
Student's School
Your answer
Please list any health concerns or special needs.
Your answer
Has the student previously participated in ASAP?
Parent/Guardian Information
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Phone Number *
Your answer
Best Contact Method for Parent/Guardian *
Demographic Information
This information is kept entirely confidential and used only for reporting to the Indiana Arts Commission (a state agency) and the National Endowment for the Arts (a federal agency.)
Student's Gender
Student's primary race
Is the student on a free or reduced school lunch program?
Emergency Contact
Please list a secondary contact should any emergency arise.
Student's Emergency Contact Name *
Should not be the same person as the primary parent/guardian listed above.
Your answer
Emergency Contact's Relation to Student
i.e. family friend, grandmother, etc.
Your answer
Emergency Contact Phone Number *
Your answer
ASAP Class Selection
You may enroll your student in more than one course. Please make sure your student does not have conflicting activities as space is limited and we require 100% commitment from students.
Please select the classes in which the student wishes to enroll: *
Required
IF APPLICABLE: Will your student need to borrow a ukulele from TAF?
Acknowledgments & Wavier
By submitting this form, my student and I agree to waive any and all claims for injury or damage against the Tippecanoe Arts Federation, and their employees, volunteers, and participating organizations, which may incur while participating in this program. The student and I will be fully responsible for any damage or injury which I cause to any property or persons, intentionally or negligently, and agree to indemnify Tippecanoe Arts Federation and its employees, volunteers, and participating organizations, including Columbian Park Zoo, while participating in this program.

My student and I grant Tippecanoe Arts Federation, its employees, volunteers, and participating organizations, full access and use of any photographs, video, or other media showing the student while participating in this program. I understand these photographs may be used by TAF for promotion of the After School Arts Program.

***Note that if you do not want your child photographed, please notify Ann Fields Monical at coo@tippecanoearts.org before the class begins.***

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