Youth Registration

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#1 Student Full Name
*
#1 Student Age
*
#2 Student Full Name
#2 Student Age
#3 Student Full Name
#3 Student Age
Address
*
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Daytime Phone Number
*
Other Contact Number
*
Email Address
*
Guardian or Head of Household Name:
*
Emergency Contact Name
*
Emergency Contact Number
*
Name and number of Doctor in case of emergency:
*
Any special medical information? Y/N If Yes, please explain:
*
Which class(es) are you enrolling in?
*
How did you hear about us?
*

School
Newspaper
Website
Friend/Family
Facebook
Other
To assist us in qualifying for program funding and grant money, please check any of the following that apply,. All information is confidential.
*
Qualifies for free lunch
Qualifies for reduced lunch
Single Parent Home
None of the Above
Are you in financial need of a scholarship or family discount?
*
Yes
No
I give consent for the above student(s) to attend classes and activities at/or sponsored by the Fine Arts Center. I understand that every effort will be made to provide a safe and well-supervised environment and offer positive, learning experience. I will make sure this student is picked up or has transportation to get home no later than 5 minutes after the end of class.
*

I Agree
I give consent for the Fine Arts Center to publish use or print articles, videos or pictures of all persons listed above for use in advertising, funding or promoting the Fine Arts Center.
*
I Agree
No, I do not want my child's picture used.
I understand that due to the Covid-19 pandemic, my child will be sent home if displaying a fever or symptoms. I also agree to keep my student home in the event they are showing symptoms or have been exposed to someone with Covid-19.
*
I agree

ONLINE YOUTH CLASS REGISTRATION FORM

Brigham City Fine Arts Center

58 South 100 West

Brigham City, UT 84302

Funded in part by grants from:

The Marie Eccles Caine Foundation / Russell Family

NF Living Trust

Brigham City corporation
Coordinated Community Trust

Regular Office Hours*:

Monday-Thursday:

9am - 1:00 pm 3:00 - 5:00 pm

Friday: 9:00 am - 1:00 pm

Summer Office Hours*:

Monday-Thursday: 9:00 am - 2:00 pm

Friday: 9:00 am - 12:00 pm

* We are here many other times

Feel free to call us at 435-730-5704

Contact webmaster

Copyright © 2017 My Website

Contact Information:

Fine Arts Center: 435-723-0740

bcfineartscenter@aol.com