Class Registration Summer 2016

I am enrolling more than one student. *

Yes

Student Name *

Student Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School *

Grade *

Birthdate *

Birthdate

YYYY

Gender *

Age *

Race *

Which class?

Waiting List Only - Community Clay

Waiting List Only - Comic Drawing

Second Student Registration (If Applicable)

Second Student Name (If Applicable)

First Name

Last Name

Birthday (Second Student if Applicable)

YYYY

School (If different from First student)

Grade

Which Class *

Please select all that apply

NA if only ONE student is being registered

Waiting List Only- Community Clay

Waiting List Only - Comic Drawing

Third Student Registration (If Applicable)

Third Student Name (If Applicable)

First Name

Last Name

Birthday (Third Student)

YYYY

School (if different than First Student)

Grade

Which Class? *

Please select all that apply

NA if only ONE or TWO students are being registered

Waiting List Only -Community Clay

Waiting List Only - Comic Drawing

Emergency Contact

Guardian Email

Student Email

Receive Emails from Elevarte?

Opt into our email list and receive the ElevArte Newsletter with updates on class offerings and calendar dates with our latest events.

Yes

Parent/Guardian Name *

Parent/Guardian Name

First Name

Last Name

Parent or Guardian Phone *

Parent or Guardian Phone

(###)

###

####

Second Emergency Contact Person *

Second Emergency Contact Person

First Name

Last Name

Emergency Contact Phone *

Emergency Contact Phone

(###)

###

####

Relationship to Student

Terms of Agreement *

I have provided accurate contact information and I give permission for my child to engage in the activities selected above; including field trips, and/or visits to other locations, which will be announced as they occur. I have read the above class descriptions and understand that there are certain risks of injury to participants. I fully release and discharge ElevArte Community Studio and its officers, agents, servants and employees from any and all claims from injuries, damage or loss which I or my minor child/ward may have or which may accrue to me or my child/ward and arising out of, connected with or in any way associated with the activities of the program. I also give permission to ElevArte Community Studio to use photographs and video of activities that contain an image of my child (if under 18) or me for the limited purpose of promotion and advertising.

Thank you for signing up! Read more details below:

We ask that you arrive a little early to fill out some quick paperwork.

Community Clay and Comic Drawing meet at ElevArte Community Studio in Residence at Dvorak Park: 1119 W. Cullerton St., in the basement.

Questions? Call 312-226-7767.

We look forward to seeing you!