BCAI-CAH class/session registration
This form, along with payment secures your spot in the class(es) you desire. All questions can be directed to BreakingChains116@gmail.com or 309-532-4272

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Email *
Primary Guardian first & last name and pronouns *
Primary Guardian phone number *
Have you registered for BCAI yet via www.BCAIarts.org? *
Which class/session are you registering for/committing to? *
Who are you registering? INCLUDE ALL 4 OF THE FOLLOWING: (1) Preferred name(s) of ALL you are registering, (2) gender pronouns, (3) ages, (4) any needed accommodations and (5) anything you need us to know about you or your child(ren) such as traumas, sensitivities, allergies etc *
Would you like to discuss payment assistance options? *
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