Class Sign-up Form

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Class Sign-up Form

Student Information

Student Name *

First and Last

preferred name or also known as

Grade *

Teacher Information *

Teacher's name

After Class Care Options *

After class my child will?

Wait to be picked up

Walk or ride bike home

Catalyst

ELOP

EXL

Tutor Time

YMCA

Other:

Parent Information

Parent Name *

First and Last

Phone Number *

Email Address *

Alternate/Emergency Contact

Please provide the name and phone number of an alternate contact person. *Not Required*

Class Information

Please note that not all classes may be options at your schools site for this session

Which IAC Club are you joining? *

Check all classes that your child is signing up for. Please note not all classes are held at your school site, refer to what is being offered at your school for this current session

Art Club

Arts & Crafts

Basketball

Chess

Comic Book Art Club

Creative Writing

Flag Football

Performing Arts

Pickleball

Public Speaking Class

Soccer

Volleyball

Other:

Required

Elementary School *

School where the class will be held

Payment Type

Please choose your preferred payment method below. *

Check payments can be mailed to the address on the flyer. Credit Card payments will be invoiced from Square once the minimum number of students have enrolled.

Check

Credit Card

Zelle

IAC Certificate

IAC Authorization

Please scroll to the top of the page after submitting the form to verify that it has been received.

I, the undersigned parent or legal guardian of the child named above, hereby give my consent and approval for my child to participate in the activity organized by IAC. I understand that the activity may involve certain risks and hazards, such as injury, illness, or property damage, and I agree to assume all such risks on behalf of myself and my child. I also agree to release, indemnify, and hold harmless IAC, its employees, volunteers, agents, and contractors from any and all liability, claims, costs, or damages arising from or related to my child’s participation in the activity, whether caused by negligence or otherwise. I have read and understood this waiver and I sign it voluntarily.

I agree

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