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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
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Guardian or Head of Household Name:
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Emergency Contact Name
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Name and number of Doctor in case of emergency:
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Any special medical information? Y/N If Yes, please explain:
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Which class(es) are you enrolling in?
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To assist us in qualifying for program funding and grant money, please check any of the following that apply,. All information is confidential.
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Qualifies for free lunch
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Are you in financial need of a scholarship or family discount?
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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.
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I agree
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ONLINE YOUTH CLASS REGISTRATION FORM